He et al., 2012 Fall rates among No intervention - No specific Inpatient falls Retrospective Higher HPPD and RN skill Fall rate 3e adult patients in used annual comparator observational mix were significantly 8915 nursing average nursing study associated with lower fall units in 1171 US hours per patient rates (IRR: 0.95 for HPPD acute care day and percent and 0.99 for RN skill mix) hospitals of total hours of for all units together, (included 1994 care provided by associations consistent at critical care units RNs unit level, results not & 1328 reported units) Hugonnet, Adult ICU patients workload Low staffing level Nosocomial infection Prospective Significant association Nosocomial infection 3e Chevrolet, & (n=1,883) with measured by 24-h cohort between nurse patient – Pittet, 2007 ICU stay > 48 h in nurse-to-patient ratio and nosocomial Geneva, ratio. infections (RR 0.69 (0.50 – Switzerland 0.95) Hugonnet, Adult patients No intervention - No specific Prospective Significant association Late-onset ventilator 3e Uçkay, & Pittet, (n=2470) calculated a 24 comparator cohort study between nurse/patient associated 2007 admitted to a hour pneumonia ratio and late-onset VAP pneumonia medical ICU in nurse/patient HR: 0.42 (0.18, 0.99) but Switzerland ratio and a mean not for early-onset VAP ratio per shift HR: 0.78 (0.42, 1.45) Hugonnet, Adult patients Nurse/patient Lower nurse Nosocomial infection Case-crossover Relationship between Nosocomial infection 3c & Villaveces & (n=366) admitted ratio staffing (< 1.9) and cohort nurse-patient ratio and 3d Pittet, 2007 to a medical ICU designs infection. For cohort in Geneva, design OR 1.47 (1.03, Switzerland 2.11); for case-crossover design logistic analysis OR 1.89 (1.16, 3.07) and GEE analysis OR 1.58 (1.08, 2.33)
He et al., 2012 Fall rates among adult patients in 8915 nursing units in 1171 US acute care hospitals (included 1994 critical care units & 1328 units) No intervention - used annual average nursing hours per patient day and percent of total hours of care provided by RNs No specific comparator Inpatient falls Retrospective observational study Higher HPPD and RN skill mix were significantly associated with lower fall rates (IRR: 0.95 for HPPD and 0.99 for RN skill mix) for all units together, associations consistent at unit level, results not reported Fall rate 3e Hugonnet, Chevrolet, & Pittet, 2007 Adult ICU patients (n=1,883) with ICU stay > 48 h in Geneva, Switzerland workload measured by 24-h nurse-to-patient ratio. Low staffing level Nosocomial infection Prospective cohort Significant association between nurse – patient ratio and nosocomial infections (RR 0.69 (0.50 – 0.95) Nosocomial infection 3e Hugonnet, Uçkay, & Pittet, 2007 Adult patients (n=2470) admitted to a medical ICU in Switzerland No intervention - calculated a 24 hour nurse/patient ratio and a mean ratio per shift No specific comparator pneumonia Prospective cohort study Significant association between nurse/patient ratio and late-onset VAP HR: 0.42 (0.18, 0.99) but not for early-onset VAP HR: 0.78 (0.42, 1.45) Late-onset ventilator associated pneumonia 3e Hugonnet, Villaveces & Pittet, 2007 Adult patients (n=366) admitted to a medical ICU in Geneva, Switzerland Nurse/patient ratio Lower nurse staffing (< 1.9) Nosocomial infection Case-crossover and cohort designs Relationship between nurse-patient ratio and infection. For cohort design OR 1.47 (1.03, 2.11); for case-crossover design logistic analysis OR 1.89 (1.16, 3.07) and GEE analysis OR 1.58 (1.08, 2.33) Nosocomial infection 3c & 3d
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