Bolton et al., Falls data from 65 Hours of nursing Staffing changes Falls and falls with Longitudinal Significant association Falls, falls with 3e 2007 step-down units care/patient day; pre/post injury; study pre/post between % of care by RNs injuries, and pressure nurse/patient introduction of pressure mandated & any pressure ulcer and ratios and skill mandated ulcers; restraint use nurse staffing Significant positive ulcers restraint use data mix pre/post staffing ratios ratios association between from 40 introduction of higher total hours of care units in mandated nurse per patient day & higher Californian staffing ratios prevalence of stage II+ hospitals pressure ulcers - No significant results or trends in relationship between staffing variables & restraint prevalence. Checkley et al., 69 ICUs in 42 No intervention, Bed-to-nurse ICU mortality Prospective Significantly lower ICU mortality 3e 2014 hospitals centres Bed-to-nurse ratio of 2:1 observational mortality, 1.8% lower in the US. May ratio of 1.5:1 study when the bed-to-nurse include some ratio decreased from 2:1 paediatric ICUs. to 1.5:1 No information on patient numbers Chittawatanarat 155 ICUs in 87 Average Higher/lower NPR Mortality (monthly Retrospective Increased NPR significantly Ventilator days 3e et al., 2014 hospitals in ratio crude mortality observational associated with decreased Thailand (90% of (NPR) each shift rate), average study number of ventilator days sample were ventilator days, ICU (-2.08 [-5.377 to -0.166], p adult ICUs but length of stay = 0.037). NPR not some paediatric). significantly associated 104,046 patient with crude mortality or admissions used ICU-LOS. for mortality calculations Cho et al., 2008 Adult patients No specific No specific In-hospital mortality Cross sectional Significant relationship In-hospital mortality 4b (n=27,372) in intervention comparator between nurse patient ICUs in 236 ratio and mortality in Korean hospitals secondary hospitals (OR 1.43)
Bolton et al., 2007 Falls data from 65 step-down units and pressure ulcer and restraint use data from 40 units in Californian hospitals Hours of nursing care/patient day; nurse/patient ratios and skill mix pre/post introduction of mandated nurse staffing ratios Staffing changes pre/post introduction of mandated staffing ratios Falls and falls with injury; pressure ulcers; restraint use Longitudinal study pre/post mandated nurse staffing ratios Significant association between % of care by RNs & any Significant positive association between higher total hours of care per patient day & higher prevalence of stage II+ pressure ulcers - No significant results or trends in relationship between staffing variables & restraint prevalence. Falls, falls with injuries, pressure ulcers 3e Checkley et al., 2014 69 ICUs in 42 hospitals centres in the US. May include some paediatric ICUs. No information on patient numbers No intervention, Bed-to-nurse ratio of 1.5:1 Bed-to-nurse ratio of 2:1 ICU mortality Prospective observational study Significantly lower mortality, 1.8% lower when the bed-to-nurse ratio decreased from 2:1 to 1.5:1 ICU mortality 3e Chittawatanarat et al., 2014 155 ICUs in 87 hospitals in Thailand (90% of sample were adult ICUs but some paediatric). 104,046 patient admissions used for mortality calculations Average ratio (NPR) each shift Higher/lower NPR Mortality (monthly crude mortality rate), average ventilator days, ICU length of stay Retrospective observational study Increased NPR significantly associated with decreased number of ventilator days (-2.08 [-5.377 to -0.166], p = 0.037). NPR not significantly associated with crude mortality or ICU-LOS. Ventilator days 3e Cho et al., 2008 Adult patients (n=27,372) in ICUs in 236 Korean hospitals No specific intervention No specific comparator In-hospital mortality Cross sectional Significant relationship between nurse patient ratio and mortality in secondary hospitals (OR 1.43) In-hospital mortality 4b
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