Hospital mortality drops with lower patient-to-nurse ratio

Registered nurses responsible for six or fewer patients at a time showed a 20 percent decrease in hospital mortality rates.
By Stephen Feller  |  Feb. 10, 2016 at 10:41 AM
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SOUTHAMPTON, England, Feb. 10 (UPI) -- Hospitals with more registered nurses and doctors per bed can reduce patient death by as much as 20 percent, researchers in England found in a study of clinics there.

Having more nurses and doctors overall is not enough, as researchers at the University of Southampton found having more unregistered nurses increased the death rate at hospitals.

The researchers focused on cost-cutting measures -- either reducing overall staff, or hiring unregistered healthcare support workers to reduce workload -- as at fault for some part of current mortality rates.

"When determining the safety of nurse staffing on hospital wards, the level of registered nurse staffing is crucial -- hospitals with higher levels of healthcare support workers have higher mortality rates," said Jane Ball, a research fellow at the Karolinska Institutet, in a press release. "Patients should not be asked to pay the price of receiving care from a less skilled and less educated member of staff, just to make up for the failure of the system to ensure enough registered nurses. Staffing decisions need to be made on the basis of patient safety, not on the basis of finance. Current policies geared towards substituting [these] workers for registered nurses should be reviewed."

For the study, published in the British Medical Journal, researchers reviewed administrative data from 137 acute care trusts in the United Kingdom's National Health Service, as well as surveys of 2,917 registered nurses at 31 of the trusts, which includes 46 hospitals and 401 wards.

The researchers found death rates were 20 percent lower when nurses are responsible for six or fewer patients, as compared to nurses responsible for 10 or more patients. On surgical wards, deaths rates were 17 percent lower with the lower nurse to patient ratio.

These rates remained relatively stable when researchers factored in age, medical conditions, and other factors during patients' previous 12 months of care.

The researchers caution the study does not show a cause-and-effect scenario, but indicates more careful staffing of facilities with an eye on training rather than funding could help reduce mortality rates at hospitals.

"This does not, in itself, provide a robust basis to identify safe staffing thresholds but given the overall strength of evidence for an association, we are showing that, in England, the registered nursing workforce is clearly associated with patient safety," said Peter Griffiths, a professor at the University of Southampton. "We found no evidence that having more support workers is associated with reduced death rates in hospital. Some of our findings suggest the opposite. A policy of replacing registered nurses with support staff may threaten patient safety."

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