Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study.
Jane E Ball, Luk Bruyneel, Linda H Aiken and 6 others
PMID 28844649WHAT IT FOUND
Across 300 European hospitals, 30-day postoperative mortality was higher when nurses reported leaving necessary care undone.
Each 10% rise in missed care was associated with 16% higher odds of death.
Key findings
01Missed care was significantly associated with 30-day case-mix adjusted inpatient mortality, and each 10% increase in missed care was associated with a 16% increase in the odds of dying within 30 days of admission.
02Each additional patient per nurse was associated with a 7% increase in the odds of a patient dying within 30 days of admission.
03Missed care mediated the association between nurse staffing and mortality, and the direct staffing effect was no longer significant.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study design was cross-sectional, so it cannot prove that low staffing or missed care caused deaths. Missed care was based on nurses' reports about their last shift, not direct observation, and was averaged across hospitals rather than matched to individual patients. The number of nurses contributing to staffing and missed-care estimates varied across countries and hospitals, which may bias estimates. Missed care was analysed as one total score, so the study cannot say which specific missed activities mattered most for mortality. The mediation model simplified risk adjustment by summarising comorbidities and collapsing surgery types, although sensitivity analyses said this did not change Models 1 to 3 conclusions. Hospitals needed at least 100 beds, so the findings may not apply to smaller hospitals.
Declared interests
The authors declared no conflicts of interest. The supplied text does not state who funded the study.
The easy way to misread this
Do not conclude that reducing missed care will lower mortality. This was a cross-sectional observational study, and the authors state that causality cannot be proven.