'Failure to rescue' linked to higher HCA ratio
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.”