title: Exploring the relationship between nursing hours per patient day and mortality rate of hospitalised patients in Taiwan.
abstract: OBJECTIVE
  To investigate the relationship between nursing hours per patient day and the inpatient mortality rate in Taiwan.
  
  
  BACKGROUND
  Nursing hours per patient day has been associated with better patient outcomes. The literature is inconclusive on the relationship between nursing hours per patient day and the inpatient mortality rate, and no studies have yet examined this issue in Taiwan.
  
  
  METHODS
  A retrospective longitudinal study analysed data from the 'Nursing Utilization of Resources, Staffing and Environment on Outcome Study: NURSE-outcome study'. Hierarchical regression estimated the relationship between nursing hours per patient day and in-hospital mortality rate after controlling for confounding variables.
  
  
  RESULTS
  The mean nursing hours per patient day in Taiwan was 2.3, while the mean inpatient mortality rate was 0.73% higher nursing hours per patient day was associated with a lower inpatient mortality rate after controlling for confounding variables. The total explained variance of this study in inpatient mortality rate was 19.9%. Significant relationships to inpatient mortality were found in levels of hospitals, seasonal variation and nurses' work experience.
  
  
  CONCLUSIONS
  Nursing hours per patient day affects the mortality rate among hospitalised patients in Taiwan.
  
  
  CONCLUSIONS
  According to the results, we suggested the government and managers in Taiwan double the nursing hours per patient day so that the inpatient mortality rate will decline by 1.1%. This might be the optimal nurse configuration that could provide a balance between cost-effectiveness and patient safety.
authors.affiliation: Department of Nursing, National Cheng Kung University Hospital, Taiwan.
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Chang
authors.affiliation: Department of Nursing, College of Medicine, Taiwan.
authors.forename: Miaofen
authors.initials: M
authors.lastname: Yen
authors.affiliation: Department of Statistics, College of Management, Taiwan.
authors.forename: Sheng-Mao
authors.initials: SM
authors.lastname: Chang
authors.affiliation: Department of Economics & Graduate Institute of Political Economy, College of Social Sciences, National Cheng Kung University, Taiwan.
authors.forename: Ya-Ming
authors.initials: YM
authors.lastname: Liu
mesh_terms: D017052:Hospital Mortality; D006801:Humans; D008137:Longitudinal Studies; D009741:Nursing Staff, Hospital / Q000191:economics / Q000706:statistics & numerical data / Q000600:supply & distribution*; D063868:Patient Outcome Assessment; D061214:Patient Safety / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013624:Taiwan
keywords: NHPPD; inpatient mortality rate; nurse staffing; nurse-to-patient ratio; nursing hours per patient day