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Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study

Summary Background Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess wheth... Full description

Journal Title: The Lancet (British edition) 2014, Vol.383 (9931), p.1824-1830
Main Author: Aiken, Linda H, Prof
Other Authors: Sloane, Douglas M, PhD , Bruyneel, Luk, MS , Van den Heede, Koen, PhD , Griffiths, Peter, Prof , Busse, Reinhard, Prof , Diomidous, Marianna, PhD , Kinnunen, Juha, Prof , Kózka, Maria, Prof , Lesaffre, Emmanuel, Prof , McHugh, Matthew D, PhD , Moreno-Casbas, M T, PhD , Rafferty, Anne Marie, Prof , Schwendimann, Rene, PhD , Scott, P Anne, Prof , Tishelman, Carol, Prof , van Achterberg, Theo, PhD , Sermeus, Walter, Prof
Format: Electronic Article Electronic Article
Language: English
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Quelle: Alma/SFX Local Collection
Publisher: Kidlington: Elsevier Ltd
ID: ISSN: 0140-6736
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title: Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study
format: Article
creator:
  • Aiken, Linda H, Prof
  • Sloane, Douglas M, PhD
  • Bruyneel, Luk, MS
  • Van den Heede, Koen, PhD
  • Griffiths, Peter, Prof
  • Busse, Reinhard, Prof
  • Diomidous, Marianna, PhD
  • Kinnunen, Juha, Prof
  • Kózka, Maria, Prof
  • Lesaffre, Emmanuel, Prof
  • McHugh, Matthew D, PhD
  • Moreno-Casbas, M T, PhD
  • Rafferty, Anne Marie, Prof
  • Schwendimann, Rene, PhD
  • Scott, P Anne, Prof
  • Tishelman, Carol, Prof
  • van Achterberg, Theo, PhD
  • Sermeus, Walter, Prof
subjects:
  • Abridged Index Medicus
  • Aged
  • Analysis
  • Article
  • Biological and medical sciences
  • Comorbidity
  • Education
  • Education, Nursing - standards
  • Education, Nursing - statistics & numerical data
  • Educational Status
  • Epidemiology
  • Europe
  • Europe - epidemiology
  • Female
  • General aspects
  • Health participants
  • Hospital Mortality
  • Hospitals
  • Humans
  • Internal Medicine
  • Male
  • Medical sciences
  • Medicin och hälsovetenskap
  • Middle Aged
  • Mortality
  • Nurses
  • Nursing Administration Research - methods
  • Nursing education
  • Nursing Staff, Hospital - education
  • Nursing Staff, Hospital - statistics & numerical data
  • Nursing Staff, Hospital - supply & distribution
  • Outcome Assessment (Health Care) - methods
  • Patients
  • Personnel Staffing and Scheduling - statistics & numerical data
  • Postanesthesia Nursing - standards
  • Postanesthesia Nursing - statistics & numerical data
  • Public health. Hygiene
  • Public health. Hygiene-occupational medicine
  • Quality Indicators, Health Care
  • Retrospective Studies
  • Supply and demand
  • Workforce
  • Workforce planning
  • Workload - statistics & numerical data
ispartof: The Lancet (British edition), 2014, Vol.383 (9931), p.1824-1830
description: Summary Background Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. Methods For this observational study, we obtained discharge data for 422 730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26 516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. Findings An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031–1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886–0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients. Interpretation Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths. Funding European Union's Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health P
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
  • 1474-547X
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creatorAiken, Linda H, Prof ; Sloane, Douglas M, PhD ; Bruyneel, Luk, MS ; Van den Heede, Koen, PhD ; Griffiths, Peter, Prof ; Busse, Reinhard, Prof ; Diomidous, Marianna, PhD ; Kinnunen, Juha, Prof ; Kózka, Maria, Prof ; Lesaffre, Emmanuel, Prof ; McHugh, Matthew D, PhD ; Moreno-Casbas, M T, PhD ; Rafferty, Anne Marie, Prof ; Schwendimann, Rene, PhD ; Scott, P Anne, Prof ; Tishelman, Carol, Prof ; van Achterberg, Theo, PhD ; Sermeus, Walter, Prof
creatorcontribAiken, Linda H, Prof ; Sloane, Douglas M, PhD ; Bruyneel, Luk, MS ; Van den Heede, Koen, PhD ; Griffiths, Peter, Prof ; Busse, Reinhard, Prof ; Diomidous, Marianna, PhD ; Kinnunen, Juha, Prof ; Kózka, Maria, Prof ; Lesaffre, Emmanuel, Prof ; McHugh, Matthew D, PhD ; Moreno-Casbas, M T, PhD ; Rafferty, Anne Marie, Prof ; Schwendimann, Rene, PhD ; Scott, P Anne, Prof ; Tishelman, Carol, Prof ; van Achterberg, Theo, PhD ; Sermeus, Walter, Prof ; for the RN4CAST consortium ; RN4CAST consortium
descriptionSummary Background Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. Methods For this observational study, we obtained discharge data for 422 730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26 516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. Findings An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031–1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886–0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients. Interpretation Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths. Funding European Union's Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health Professionals, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Committee for Health and Caring Sciences and Strategic Research Program in Care Sciences at Karolinska Institutet, Spanish Ministry of Science and Innovation.
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1Sloane, Douglas M, PhD
2Bruyneel, Luk, MS
3Van den Heede, Koen, PhD
4Griffiths, Peter, Prof
5Busse, Reinhard, Prof
6Diomidous, Marianna, PhD
7Kinnunen, Juha, Prof
8Kózka, Maria, Prof
9Lesaffre, Emmanuel, Prof
10McHugh, Matthew D, PhD
11Moreno-Casbas, M T, PhD
12Rafferty, Anne Marie, Prof
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14Scott, P Anne, Prof
15Tishelman, Carol, Prof
16van Achterberg, Theo, PhD
17Sermeus, Walter, Prof
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descriptionSummary Background Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. Methods For this observational study, we obtained discharge data for 422 730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26 516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. Findings An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031–1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886–0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients. Interpretation Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths. Funding European Union's Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health Professionals, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Committee for Health and Caring Sciences and Strategic Research Program in Care Sciences at Karolinska Institutet, Spanish Ministry of Science and Innovation.
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28Nursing Staff, Hospital - education
29Nursing Staff, Hospital - statistics & numerical data
30Nursing Staff, Hospital - supply & distribution
31Outcome Assessment (Health Care) - methods
32Patients
33Personnel Staffing and Scheduling - statistics & numerical data
34Postanesthesia Nursing - standards
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36Public health. Hygiene
37Public health. Hygiene-occupational medicine
38Quality Indicators, Health Care
39Retrospective Studies
40Supply and demand
41Workforce
42Workforce planning
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titleNurse staffing and education and hospital mortality in nine European countries: a retrospective observational study
authorAiken, Linda H, Prof ; Sloane, Douglas M, PhD ; Bruyneel, Luk, MS ; Van den Heede, Koen, PhD ; Griffiths, Peter, Prof ; Busse, Reinhard, Prof ; Diomidous, Marianna, PhD ; Kinnunen, Juha, Prof ; Kózka, Maria, Prof ; Lesaffre, Emmanuel, Prof ; McHugh, Matthew D, PhD ; Moreno-Casbas, M T, PhD ; Rafferty, Anne Marie, Prof ; Schwendimann, Rene, PhD ; Scott, P Anne, Prof ; Tishelman, Carol, Prof ; van Achterberg, Theo, PhD ; Sermeus, Walter, Prof
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38Quality Indicators, Health Care
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genrearticle
ristypeJOUR
atitleNurse staffing and education and hospital mortality in nine European countries: a retrospective observational study
jtitleThe Lancet (British edition)
addtitleLancet
date2014
risdate2014
volume383
issue9931
spage1824
epage1830
pages1824-1830
issn
00140-6736
11474-547X
eissn1474-547X
codenLANCAO
abstractSummary Background Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. Methods For this observational study, we obtained discharge data for 422 730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26 516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. Findings An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031–1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886–0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients. Interpretation Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths. Funding European Union's Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health Professionals, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Committee for Health and Caring Sciences and Strategic Research Program in Care Sciences at Karolinska Institutet, Spanish Ministry of Science and Innovation.
copKidlington
pubElsevier Ltd
pmid24581683
doi10.1016/S0140-6736(13)62631-8
oafree_for_read