Your browser is no longer supported

For the best possible experience using our website we recommend you upgrade to a newer version or another browser.

Close

Your browser appears to have cookies disabled. For the best experience of this website, please enable cookies in your browser

We'll assume we have your consent to use cookies, for example so you won't need to log in each time you visit our site.
Learn more

'Failure to rescue' linked to higher HCA ratio

  • 35 Comments

The higher the ratio of healthcare support staff to hospital nurses the more likely surgical patients are to die from potentially treatable complications, a UK study has found.

Researchers from the University of Southampton and Dr Foster Intelligence analysed data on staffing and outcomes from 146 hospitals in England between 1997 and 2008.

Their study, published in the International Journal of Nursing Studies, showed the more support staff were employed, compared to registered nurses, the higher the rate of “failure to rescue” in hospitals.

Hospital trusts has regularly been accused of diluting the registered workforce by employing increasing numbers of cheaper support staff.

Lead study author Professor Peter Griffiths, chair of health services research Southampton University, said they had found no strong evidence that having more HCAs helped registered staff work more effectively.

“There is simply no support here for increasing the proportion of HCAs in order to improve registered nurse efficiency,” he told Nursing Times.

Last week it was revealed that London’s acute trusts saw a 5.7% rise in the number of HCAs they employed from 2010-11 to 2011-12. The numbers rose from 6,827 in September 2010 to 7,215 in September 2011, health minister Daniel Poulter said in answer to a parliamentary question.

Overall, the study found patients in hospitals with more nurses and doctors had a significantly lower risk of failure to rescue.

“Lower rates of failure to rescue were associated with a greater number of nurses per bed and doctors per bed,” the study authors said.

However, they also found that a higher number of doctors relative to the number of qualified nurses was also a factor in reducing mortality risk – suggesting that failure to rescue was not a specifically nurse sensitive indicator.

The authors also found a steep increase in deaths among older patients compared to younger ones. Although this would be expected to some extent, they said, there was no obvious reason for such a sharp increase.

For example, the failure to rescue rate was 1.6% for patients aged 18-39, but 0.5% for those aged 65-75 and 20.6% for those over 75.

The research follows on from the final results from one of the largest workforce studies of its kind, RN4CAST, which was published last year and provided significant evidence linking the hospital nurse workforce with quality of care.

Royal College of Nursing chief executive and general secretary Peter Carter said: “This research confirms what frontline nurses know: having too few nurses on a ward does not just make nursing more difficult, more importantly it puts patients at risk.

“As this research shows, it is not only the number of staff which presents this danger, it is the level of skill available on a ward at a given time. This must include enough registered nurses, who are fully trained in identifying that a patient is deteriorating, and able to intervene themselves or summon the correct help.”

He added: “We believe that there should be a guaranteed ratio of registered to non-registered nursing staff on duty. This report contains further undeniable evidence, if it were needed, of the clear and present danger of low staffing levels in UK hospitals.”

 

  • 35 Comments

Readers' comments (35)

  • I reject this piece of research!

    England's Chief Nurse who is based in the Department of Health has stated that the only problem with Nursing and Nurses in this country is the blindingly obvious (to her ) need for nurses to possess more "C's" preferably a clutch of 6 !

    Take notice of this deluded woman ! She has got a real grip on the nursing professions problems !

    These problems have nothing to do with increasing patient dependency, poor RN staffing levels and excess numbers of care assistants. Poor "management", targets and a tick box approach to providing care are all supported and endorsed by the Chief Nurse(England).

    These researchers from nasty Dr Foster and the Southampton University will really have to be reeled in and silenced. There is a huge risk that people will believe what they say and the "6C" initiative will be exposed for what it is worth which precisely nothing ! It is nonsense !

    But please don't tell anyone that it was me that told you !

    Unsuitable or offensive? Report this comment

  • How much research does the Government need to recognise that not having enough registered nurses costs lives?

    The Mail published an article about the above yesterday. Over 300 responses and many quite vitriolic towards nurses. I find it depressing.

    I can see this getting a lot worse before it gets better. We really need stronger leadership, sooner rather than later.

    Unsuitable or offensive? Report this comment

  • michael stone

    This piece of research has the huge plus-point of having analysed data from UK hospitals: all too often, foreign research, where there will inevitably be more variance from UK/English health-system circumstances, seems to be quoted as a guide to what the NHS ought to do.

    Unsuitable or offensive? Report this comment

  • DH Agent - as if ! | 23-Jan-2013 10:40 am

    sad NHS don't take more lessons from abroad in countries with highly functioning and more successful services!

    Unsuitable or offensive? Report this comment

  • michael stone

    Anonymous | 23-Jan-2013 10:49 am

    It depends on the thing being discussed - with different types of ratio between what we call HCA/nurse/doctor in other contries, and different qualifications within those categories, simply lifting studies from foreign systems is flawed. This isn't like testing whether a particular antibiotic kills a given bacterium.

    Lots of 'evidence' in the NHS is about systems that are so complex, as to make the evidence fairly dubious. Consider complaints about treatment in Care Homes - I have no doubt that there were figures before Winterbourne View, and those figures would have been used as the basis of various analyses, but after WV the number of reported incidents increased manyfold !

    Unsuitable or offensive? Report this comment

  • http://tinyurl.com/9wrny4b
    This is the full article. Obviously as a manager, I have the time to read this. Lying on a chaise longue being fanned by ostrich feathers and eating peeled grapes.....
    The BIG caveat if you look at the conclusion is that they didn't disaggregate medical staffing. So you might have "enough" nurses but then not enough doctors to e.g. approve a dose change or carry out some sort of intervention (a high number of patients are medical not surgical). They also include day cases, which is a bit weird (younger, healthier people more likely to have that than complex elderly?). Plus they didn't measure what comorbidities patients had on admission.
    But the literature in surgery elsewhere shows that it isn't "the more you do, the better you are" it's actually inversely proportional to activity. There's a closer correlation between good outcome and e.g. ratio of nurses to patients in ITU or infection control (etc etc).
    Oooh, roast swan for lunch, must dash.

    Unsuitable or offensive? Report this comment

  • DH Agent - as if ! | 23-Jan-2013 11:13 am

    sad NHS don't take more lessons from abroad in countries with highly functioning and more successful services!

    Unsuitable or offensive? Report this comment

  • Re comment by 'The manager' above. Thanks for engaging in the full paper and you are quite right - we were unable to dis-aggregate qualified staff for some analyses - the finding the having MORE doctors per nurse (or more nurses per doctor if you like) is associated with higher levels of failure to rescue is instructive though - clearly you need BOTH and medical input is crucial here. We included day cases because this ensures that the population studied is constant across hospitals - day case rates still vary hugely. Because few of these patients experience life threatening complications few of them are likely to enter the analysis though. [Peter Griffiths - lead study author]

    Unsuitable or offensive? Report this comment

  • I don't think it is the amount of HCAs to Nurses is the problem with failure to rescue but the problem lies with the person who play's doctor and recognition of a time to act . The signs of a patient deteriating can easily be reported to the appropriate staff however, it is when to act is the biggest descision and this is rearly made by HCAs. Chain of command and who decides to call the doctor or the emergency team. Even though more staff is required to tailor for the ever growing patient numbers in hospitals and care homes.To deal with new and complicated illnesses training will have to be provided to those who work in high risk areas of nursing to maintain life until the nurse or doctor arrives.

    Unsuitable or offensive? Report this comment

  • Colin Jordan

    I don't think it is the amount of HCAs to Nurses is the problem with failure to rescue but the problem lies with the person who play's doctor and recognition of a time to act . The signs of a patient deteriating can easily be reported to the appropriate staff however, it is when to act is the biggest descision and this is rearly made by HCAs. Chain of command and who decides to call the doctor or the emergency team. Even though more staff is required to tailor for the ever growing patient numbers in hospitals and care homes.To deal with new and complicated illnesses training will have to be provided to those who work in high risk areas of nursing to maintain life until the nurse or doctor arrives. And perhaps this is the reason for more registered nurses to be borne in to the system because of there training?

    Unsuitable or offensive? Report this comment

Show 102050results per page

Have your say

You must sign in to make a comment

Please remember that the submission of any material is governed by our Terms and Conditions and by submitting material you confirm your agreement to these Terms and Conditions. Links may be included in your comments but HTML is not permitted.

Related Jobs