1
|
Peutere L, Pentti J, Ropponen A, Kivimäki M, Härmä M, Krutova O, Ervasti J, Koskinen A, Virtanen M. Association of nurse understaffing and limited nursing work experience with in-hospital mortality among patients: A longitudinal register-based study. Int J Nurs Stud 2024; 150:104628. [PMID: 37992652 DOI: 10.1016/j.ijnurstu.2023.104628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Although nurse understaffing and limited nursing work experience may affect hospital patients' risk of mortality, relatively little longitudinal patient-level evidence on these associations is available. Hospital administrative data could provide important information about the level of staffing, nurses' work experience and patient mortality over time. OBJECTIVE To examine whether daily exposure to nurse understaffing and limited nursing work experience is associated with patient mortality, using patient-level data with different exposure time windows and accounting for several patient-related characteristics. METHODS This longitudinal register-based study combined administrative data on patients (clinical database Auria) and employees (Titania® shift-scheduling) from one hospital district in Finland in 2013-2019, covering a total of 254,446 hospital stays in 40 units. We quantified nurse understaffing as the number of days with low nursing hours in relation to target hours (<90 % of the annual unit median), and limited work experience as the number of days with a low proportion of nurses with >3 years of in-hospital experience, and those aged over 25 (<90 % of the annual unit median). We used two survival model designs to analyze the associations between nurse understaffing and limited nursing work experience and the in-hospital mortality of the patients: we considered these exposures during the first days in hospital and as a cumulative proportion of days with suboptimal staffing during the first 30 days. RESULTS In total, 1.5 % (N = 3937) of the hospital stays ended in death. A 20 % increase in the proportion of days with nurse understaffing was associated with an increased, 1.05-fold mortality risk at the patient level (95 % confidence interval, 1.01-1.10). The cumulative proportion of days with limited nursing work experience, or the combination of nurse understaffing and limited work experience were not associated with increased risk of death among all patients. However, both indicators of limited nursing work experience were associated with an increased mortality risk among patients with comorbidities (HR 1.05, 95 % CI 1.02-1.08 and HR 1.05, 95 % CI 1.00-1.10, respectively). CONCLUSIONS Nurse understaffing was associated with a slight, but a potentially critical increase in patient in-hospital mortality. Limited nursing work experience was associated with increased in-hospital mortality in a subgroup of patients with comorbidities. Increased use of administrative data on planned and realized working hours could be a routine tool for reducing avoidable in-hospital mortality.
Collapse
Affiliation(s)
- Laura Peutere
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland; Finnish Institute of Occupational Health, Helsinki, Finland.
| | - Jaana Pentti
- Department of Public Health, University of Turku, Turku, Finland
| | - Annina Ropponen
- Finnish Institute of Occupational Health, Helsinki, Finland; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mika Kivimäki
- Finnish Institute of Occupational Health, Helsinki, Finland; Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Mikko Härmä
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Oxana Krutova
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jenni Ervasti
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Aki Koskinen
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
2
|
Zuin M, Rigatelli G, Bilato C. Weekend atrial fibrillation hospitalizations are associated with higher short-term mortality. Acta Cardiol 2023; 78:1006-1011. [PMID: 37339243 DOI: 10.1080/00015385.2023.2223007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 05/13/2023] [Accepted: 05/31/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Previous investigations have analysed the relationship between weekend (WE) admission and early death in patients with atrial fibrillation (AF) patients without reaching univocal results. We systematically reviewed the available literature and performed a meta-analysis of data from cohort studies to estimate the association between WE admission and short-term mortality in AF patients. METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. We searched relevant publications using MEDLINE and Scopus from inception until 15 November 2022. Studies reporting the mortality risk as an adjusted odds ratio (OR), with relative 95% confidence interval (CI) comparing early (in-hospital or 30-day) mortality between patients admitted during the WE (Friday to Sunday) versus weekdays (WD) and having confirmed AF were included into the analysis. Data were pooled using a random-effects models with OR and related 95% CI. RESULTS Overall, 5.164.986 AF patients (mean age 69.7 years old, 47.6% males) enrolled in five retrospective investigations were considered for the analysis. A random-effect model evidenced that AF patients admitted during the WE had a higher risk of 30-day or in-hospital death (adjusted OR: 1.57; 95% CI, 1.05-1.27, p = .003, I2 = 64.7%). Sensitivity analysis confirmed yielded results. A meta-regression analysis showed a relationship between mortality and the mean age of the studies included (p = .001) while no associations were identified using sex as moderating variables (p = .15). CONCLUSIONS Patients admitted during WE for AF are characterised by an approximately 58% excess in the risk of early death.
Collapse
Affiliation(s)
- Marco Zuin
- Department of Cardiology, West Vicenza Hospital, Arzignano, Italy
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | | | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano, Italy
| |
Collapse
|
3
|
Rakici SY, Terzi O. Oncology mortality: weekend and summer vacation effect. BMJ Support Palliat Care 2023:spcare-2022-004143. [PMID: 37041072 DOI: 10.1136/spcare-2022-004143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/29/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVES In this study, we investigated the effect of the weekend and summer vacation on mortality in patients with cancer. METHODS All patient data were obtained from their hospital registry records and the Death Notification System of the Ministry of Health. RESULTS The majority of patients died in the hospital compared at home, 80.8% versus 19.2%, respectively. Patients aged <65 died mostly in hospital, which was the opposite of those aged ≥65, who died at home. While tumour location and histopathological type had no effect on the place of death, patients with metastasis (including single organ metastasis), diffuse metastases (diffuse metastases: multiple organ metastases) and patients with locally advanced stage disease were found to die more frequently in the hospital. Deaths in the hospital occurred most frequently in August, while deaths at home occurred most frequently in April and October. Deaths in the hospital occurred most frequently on Friday, Saturday and Sunday, while deaths at home occurred more frequently on Monday. It was determined that the deaths in the hospital were significantly higher at the weekend. CONCLUSION This study contains data supporting the weekend effect in oncology patients. Moreover, it provides new data on the increased death rates in August, which coincides with the summer vacation leave month.
Collapse
Affiliation(s)
| | - Ozlem Terzi
- Department of Public Health, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
| |
Collapse
|
4
|
Cohen DA, Thomas Perez LS, Chemas-Velez MM, Tseng CC, Eloy JA, Fang CH. Analysis of Care and Outcomes for Epistaxis Weekend Admissions. Otolaryngol Head Neck Surg 2023; 168:1401-1410. [PMID: 36939540 DOI: 10.1002/ohn.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/23/2022] [Accepted: 12/07/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To study differences in care of patients admitted for epistaxis during the weekend compared to the weekday. STUDY DESIGN Retrospective database review. SETTING 2003 to 2014 National Inpatient Sample. METHODS Patients admitted for a primary diagnosis of epistaxis were extracted from the National Inpatient Sample from 2003 to 2014. Univariate and multivariate analyses were applied to assess differences in patient demographics, clinical characteristics, treatment, and outcomes between weekend and weekday admissions. RESULTS A total of 39,329 cases were included in our study cohort, with 28,458 weekday admissions and 10,892 weekend admissions. There was no significant difference in patient race, gender, insurance status, hospital ownership status, or location between weekend and weekday admissions (p > .05). Most weekend admissions were emergent (82.2%) and were treated with packing (51.8%). Upon performing logistic regression, the likelihood of emergent admission (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.32-1.51, p < .001) and prolonged length of stay (OR 1.11, 95% CI 1.05-1.17, p < .001) was higher for weekend admissions versus weekday admissions. Moreover, odds of packing for epistaxis were significantly higher (OR 1.14, 95% CI 1.09-1.19, p < .001) on the weekend, while odds of ligation (OR 0.88, 95% CI 0.80-0.97, p = .013) and endovascular arterial embolization (OR 0.74, 95% CI 0.65-0.84, p < .001) were lower. There were no significant differences in in-hospital mortality, patient discharge disposition, and total hospital charges (p > .05). CONCLUSION Patients primarily admitted for epistaxis over the weekend were more likely to be emergent, experienced prolonged length of stay, and be treated nonoperatively with packing, than weekday admissions. No significant differences in patient insurance or hospital ownership were identified. LEVEL OF EVIDENCE: 4
Collapse
Affiliation(s)
- David Avery Cohen
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | - Maria Manuela Chemas-Velez
- Department of Otolaryngology and Maxillofacial Surgery, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Christopher C Tseng
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Neurological Institute of New Jersey, Newark, New Jersey, USA.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center-RWJBarnabas Health, Livingston, New Jersey, USA
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA
| |
Collapse
|
5
|
Bolous NS, Graetz DE, Ashrafian H, Barlow J, Bhakta N, Sounderajah V, Dowdeswell B. Harnessing a clinician-led governance model to overcome healthcare tribalism and drive innovation: a case study of Northumbria NHS Foundation Trust. J Health Organ Manag 2022; ahead-of-print:1-16. [PMID: 36520658 PMCID: PMC10430796 DOI: 10.1108/jhom-05-2022-0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 05/26/2022] [Accepted: 10/04/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Healthcare tribalism refers to the phenomenon through which different groups in a healthcare setting strictly adhere to their profession-based silo, within which they exhibit stereotypical behaviours. In turn, this can lead to deleterious downstream effects upon productivity and care delivered to patients. This study highlights a clinician-led governance model, implemented at a National Health Service (NHS) trust, to investigate whether it successfully overcame tribalism and helped drive innovation. DESIGN/METHODOLOGY/APPROACH This was a convergent mixed-methods study including qualitative and quantitative data collected in parallel. Qualitative data included 27 semi-structured interviews with representatives from four professional groups. Quantitative data were collected through a verbally administered survey and scored on a 10-point scale. FINDINGS The trust arranged its services under five autonomous business units, with a clinician and a manager sharing the leadership role at each unit. According to interviewees replies, this equivalent authority was cascaded down and enabled breaking down professional siloes, which in turn aided in the adoption of an innovative clinical model restructure. PRACTICAL IMPLICATIONS This study contributes to the literature by characterizing a real-world example in which healthcare tribalism was mitigated while reflecting on the advantages yielded as a result. ORIGINALITY/VALUE Previous studies from all over the world identified major differences in the perspectives of different healthcare professional groups. In the United Kingdom, clinicians largely felt cut off from decision-making and dissatisfied with their managerial role. The study findings explain a governance model that allowed harmony and inclusion of different professions. Given the long-standing strains on healthcare systems worldwide, stakeholders can leverage the study findings for guidance in developing and implementing innovative managerial approaches.
Collapse
Affiliation(s)
- Nancy S. Bolous
- Department of Global Pediatric Medicine
,
St Jude Children’s Research Hospital
, Memphis, Tennessee,
USA
| | - Dylan E. Graetz
- Department of Global Pediatric Medicine
,
St Jude Children’s Research Hospital
, Memphis, Tennessee,
USA
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London
, London,
UK
- Department of Surgery and Cancer,
Imperial College London
, London,
UK
| | - James Barlow
- Business School,
Imperial College London
, London,
UK
| | - Nickhill Bhakta
- Department of Global Pediatric Medicine
,
St Jude Children’s Research Hospital
, Memphis, Tennessee,
USA
| | - Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London
, London,
UK
- Department of Surgery and Cancer,
Imperial College London
, London,
UK
| | - Barrie Dowdeswell
- Management Center Innsbruck, Internationale Hochschule GmbH
, Innsbruck,
Austria
| |
Collapse
|
6
|
Räty S, Martinez-Majander N, Suomalainen O, Sibolt G, Tiainen M, Valkonen K, Sairanen T, Forss N, Curtze S. Is the weekend effect true in acute stroke patients at tertiary stroke center? J Neurol Sci 2021; 427:117557. [PMID: 34214920 DOI: 10.1016/j.jns.2021.117557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/24/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is contradicting evidence on the outcome of emergency patients treated during weekends versus weekdays. We studied if outcome of ischemic stroke patients receiving intravenous thrombolysis (IVT) differs according to the treatment time. METHODS Our retrospective study included consecutive patients receiving IVT within 4.5 h of stroke onset between June 1995 and December 2018 at the Helsinki University Hospital. The patients were compared based on the treatment initiation either during weekdays (Monday to Friday) or weekend (Saturday and Sunday). The primary outcome was 3-month mortality and secondary outcomes comprised 3-month modified Rankin Scale (mRS) and incidence of symptomatic intracerebral hemorrhage (sICH). Additional analyses studied the effect of IVT treatment according to non-office hours, time of day, and season. RESULTS Of the 3980 IVT-treated patients, 28.0% received treatment during weekends. Mortality was similar after weekend (10.0%) and weekday (10.6%) admissions in the multivariable regression analysis (OR 0.78; 95% CI 0.59-1.03). Neither 3-month mRS (OR 0.98; 95% CI 0.86-1.12), nor the occurrence of sICH (4.2% vs 4.6%; OR 0.87; 95% CI 0.60-1.26) differed between the groups. No outcome difference was observed between the office vs non-office hours or by the time of day. However, odds for worse outcome were higher during autumn (OR 1.19; 95% CI 1.04-1.35) and winter (OR 1.15; 95% CI 1.01-1.30). CONCLUSION We did not discover any weekend effect for IVT-treated stroke patients. This confirms that with standardized procedures, an equal quality of care can be provided to patients requiring urgent treatment irrespective of time.
Collapse
Affiliation(s)
- Silja Räty
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Olli Suomalainen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Gerli Sibolt
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marjaana Tiainen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kati Valkonen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tiina Sairanen
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nina Forss
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sami Curtze
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| |
Collapse
|