Glance et al., Adult patients Hours per Patient (i) Bottom & top In-hospital mortality, sectional 15 min increase in LPN In-hospital mortality; 4b 2012 (n=70,142) Day (HPPD) for quartiles of LPN healthcare HPPD associated with sepsis; pneumonia admitted with registered nurses HPPD;(ii) staffing associated death OR 1.15 (1.05, 1.25) trauma from 77 (RN), licensed ratio of LPN infections, and sepsis OR 1.27 (1.11, Level I and II practical nurses staffing to total (FTR) 1.45). 1% increase in ratio hospitals in the (LPN), and nurses' nurse staffing of LPN to total nursing United States aides (NA) time associated with (sample may mortality OR 1.04 include paediatric and sepsis OR 1.06 patients) (1.03-1.10). 15 min increase in NA HPPD associated with pneumonia OR 0.92 (0.87, 0.98). Hospitals in highest quartile of LPN staffing had 3 excess deaths per 1000 patients and 5 more episodes of sepsis than hospitals in lowest quartile LPN staffing. Grundmann et Adult patients No intervention - No specific Presence of MRSA Observational Relationship between MRSA presence 3e al., 2002 (n=782) in one used the average comparator study nursing staff deficits ICU in a tertiary number of nurses (greater than 1:1 care hospital in per shift over a 24 nurse/patient ratio) and the UK hour period development of MRSA - Risk ratio 1.05 (1.02, 1.08) Halwani, et al., Adult ICU patients Nurse-patient Understaffing Cross-contamination Prospective Relationship between Cross-contamination 3e 2006 (n=430) with ICU ratio defined as less with nosocomial cohort study cross-contamination and with nosocomial stay > 48 h in one than optimal infections patients experiencing pathogens hospital in staffing level (1:1 understaffing for whole Nottingham, UK during 24-h ICU stay compared with period) patients who were not exposed to understaffing OR 3.07 (1.41-6.66)
Glance et al., 2012 Adult patients (n=70,142) admitted with trauma from 77 Level I and II hospitals in the United States (sample may include paediatric patients) Hours per Patient Day (HPPD) for registered nurses (RN), licensed practical nurses (LPN), and nurses' aides (NA) (i) Bottom & top quartiles of LPN HPPD;(ii) staffing ratio of LPN staffing to total nurse staffing In-hospital mortality, healthcare associated infections, (FTR) sectional 15 min increase in LPN HPPD associated with death OR 1.15 (1.05, 1.25) and sepsis OR 1.27 (1.11, 1.45). 1% increase in ratio of LPN to total nursing time associated with mortality OR 1.04 and sepsis OR 1.06 (1.03-1.10). 15 min increase in NA HPPD associated with pneumonia OR 0.92 (0.87, 0.98). Hospitals in highest quartile of LPN staffing had 3 excess deaths per 1000 patients and 5 more episodes of sepsis than hospitals in lowest quartile LPN staffing. In-hospital mortality; sepsis; pneumonia 4b Grundmann et al., 2002 Adult patients (n=782) in one ICU in a tertiary care hospital in the UK No intervention - used the average number of nurses per shift over a 24 hour period No specific comparator Presence of MRSA Observational study Relationship between nursing staff deficits (greater than 1:1 nurse/patient ratio) and development of MRSA - Risk ratio 1.05 (1.02, 1.08) MRSA presence 3e Halwani, et al., 2006 Adult ICU patients (n=430) with ICU stay > 48 h in one hospital in Nottingham, UK Nurse-patient ratio Understaffing defined as less than optimal staffing level (1:1 during 24-h period) Cross-contamination with nosocomial infections Prospective cohort study Relationship between cross-contamination and patients experiencing understaffing for whole ICU stay compared with patients who were not exposed to understaffing OR 3.07 (1.41-6.66) Cross-contamination with nosocomial pathogens 3e
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