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Higher ratio of nurses per hospital bed linked to fewer patient deaths

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A higher ratio of nurses per hospital bed has been linked to a lower risk of death following emergency general surgery, according to new research looking at mortality rates in England.

The study, published in the British Journal of Anaesthesia, analysed nearly 300,000 cases at 156 trusts over a five-year period.

Researchers behind the study – called Mortality of emergency general surgical patients and associations with hospital structures and processes – estimated the likelihood of patient death at 30 days after emergency surgery was 7% higher in trusts with the lowest numbers of nurses per bed.

“This is the first analysis on this scale for emergency general surgical admissions examining the associations between the numbers of …nurses per hospital bed and patient survival rates”

Dr Peter Holt 

 

 

In the nine hospitals that had lower than expected death rates 30 days after admission, they found a “significantly greater provision” of nurses, doctors and surgeons per bed than in the 14 organisations with higher than expected mortality rates.

Hospitals with the lower than expected mortality rates had on average 24% more nurses, as well as 44% more doctors, per bed than those with the highest rates.

In these better performing trusts, there were on average 2.3 nurses per bed, compared with 1.8 nurses per bed in those with the worst death rates.

The study also found the trusts with lower mortality rates had 65% more critical care beds per standard ward bed.

“Crucially, the research found that in the trusts performing better than expected, the patients had a greater number of pre-existing medical conditions, and were 27% more likely to suffer complications during treatment,” said researchers behind the report.

They added: “However, these trusts had the highest staffing levels of surgical consultants, junior surgical doctors and nurses.

“Despite sicker patients and higher recorded complication rates, these trusts had 60% fewer deaths at 30 days than trusts performing less well than expected.”

“Crucially, the research found that in the trusts performing better than expected, the patients had a greater number of pre-existing medical conditions”

BJA research on mortality rates

Joint study author Dr Peter Holt said: “This is the first analysis on this scale for emergency general surgical admissions examining the associations between the numbers of senior doctors, junior doctors and nurses per hospital bed and patient survival rates.

“Although we have not demonstrated causation, we believe the findings should form an important part of the debate over disparities in staffing levels and resource provision between NHS trusts.

Commenting on the findings, Royal College of Nursing Wales said it provided further evidence of the “clear” relationship between nurse staffing levels and patient-care outcomes.

RCN Wales associate director of employment relations Peter Meredith-Smith said: “As well as having a detrimental impact on patient care and outcomes, the inadequate staffing of clinical areas also has a negative impact on nurses’ health, causing a rise in work-related stress and increasing sickness levels.”

“High-quality patient care depends on the skills and experiences of nurses, a safe environment and safe nursing numbers”

RCN Wales

“High-quality patient care depends on the skills and experiences of nurses, a safe environment and safe nursing numbers,” he added.

Mr Meredith-Smith pointed to a bill for safe nurse staffing levels, which is part way through the legislative process in Wales.

Last month, the bill moved another step closer to becoming law after successfully passing through a vote on amendments.

“Without a law like this our lives and the lives of those we care about are being put at risk. The bill will improve patient care and ensure better outcomes,” he said.

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