Evaluation of hospital nurse-to-patient staffing ratios and sepsis bundles on patient outcomes

• Type of Material: Article
• Authors: Karen B Lasater, University of Pennsylvania; Douglas M Sloane, University of Pennsylvania; Matthew D McHugh, University of Pennsylvania; Jeannie Cimiotti, Emory University; Kathryn A Riman, University of Pennsylvania; Brendan Martin, National Council of State Boards of Nursing; Maryann Alexander, National Council of State Boards of Nursing; Linda H Aiken, University of Pennsylvania
• Language: English
• Date: 2021-06-29
• Publisher: MOSBY-ELSEVIER
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ajic.2020.12.002
• Title of Journal or Parent Work: AMERICAN JOURNAL OF INFECTION CONTROL
• Volume: 49
• Issue: 7
• Start Page: 868
• End Page: 873
• Grant/Funding Information: Funding for this work was provided by the National Council of State Boards of Nursing (NCSBN) (Lasater, PI); National Institute of Nursing Research, National Institutes of Health (R01NR014855, Aiken, PI; T32NR007104, Aiken, Lake, McHugh, MPIs); and Agency for Healthcare Research and Quality (R01HS026232 Cimiotti, PI).
• Keywords: ASSOCIATION; Public, Environmental & Occupational Health; Life Sciences & Biomedicine; Nursing; Science & Technology; SAFETY; Infectious Diseases; Health services research; MORTALITY; HEALTH; BURNOUT; Acute care

Abstract

Background: Despite nurses’ responsibilities in recognition and treatment of sepsis, little evidence documents whether patient-to-nurse staffing ratios are associated with clinical outcomes for patients with sepsis. Methods: Using linked data sources from 2017 including MEDPAR patient claims, Hospital Compare, American Hospital Association, and a large survey of nurses, we estimate the effect of hospital patient-to-nurse staffing ratios and adherence to the Early Management Bundle for patients with Severe Sepsis/Septic Shock SEP-1 sepsis bundles on patients’ odds of in-hospital and 60-day mortality, readmission, and length of stay. Logistic regression is used to estimate mortality and readmission, while zero-truncated negative binomial models are used for length of stay. Results: Each additional patient per nurse is associated with 12% higher odds of in-hospital mortality, 7% higher odds of 60-day mortality, 7% higher odds of 60-day readmission, and longer lengths of stay, even after accounting for patient and hospital covariates including hospital adherence to SEP-1 bundles. Adherence to SEP-1 bundles is associated with lower in-hospital mortality and shorter lengths of stay; however, the effects are markedly smaller than those observed for staffing. Discussion: Improving hospital nurse staffing over and above implementing sepsis bundles holds promise for significant improvements in sepsis patient outcomes.