nurse staffing issues - complications
A new study of a national sample of over 500 hospitals suggests
that concern about nurse staffing may be warranted. The study
demonstrated a connection between fewer RN hours per patient day
and more cases of postoperative pneumonia among patients
undergoing major surgery.
Chunliu Zhan, M.D., Ph.D., Peter J. Gergen, M.D., M.P.H., and
Jayasree Basu, Ph.D., of the Agency for Healthcare Research and
Quality, and their colleagues linked discharge data from hospitals
in 13 States from 1990 to 1996 with American Hospital Association
data on hospital characteristics and nurse staffing. They used
these data to examine the impact of nurse staffing on four
postsurgical complications: venous thrombosis/pulmonary embolism,
pulmonary compromise, urinary tract infection (UTI), and
pneumonia, among patients undergoing major surgery.
After controlling for other factors—such as patient case mix
and hospital characteristics—fewer RN hours per patient day were
found to be significantly associated with more postsurgical
pneumonia. Contrary to anecdotal reports of declining RN staffing
levels, this study found slightly increased RN hours per patient
day, as well as steady increases in physician and resident/intern
hours per patient day during the study period.
This study, which used different data and different methods,
reached the same conclusions as another recent AHRQ-funded study
by Jack Needleman, Ph.D., of the Harvard School of Public Health,
and Peter Buerhaus, Ph.D., R.N., of the Vanderbilt University
School of Nursing. Their findings were published in the May 30,
2002 issue of the New England Journal of Medicine 346(22),
pp. 1715-1722.
For more information on the current study, see "Nurse staffing
and postsurgical adverse events: An analysis of administrative
data from a sample of U.S. hospitals, 1990-1996," by Christine
Kovner, Ph.D., R.N., Cheryl Jones, R.N., Ph.D., Dr. Zhan, and
others, in the June 2002 Health Services Research 37(3),
pp. 611-629.
Reprints (AHRQ Publication No. 02-R079) are available from the
AHRQ Publications Clearinghouse.
These are excerpts from the AHRQ Research Activities,
you can read the full report at
http://www.ahrq.gov/research/aug02/0802RA11.htm |