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. 2021 Jul;49(7):868-873.
doi: 10.1016/j.ajic.2020.12.002. Epub 2020 Dec 10.

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

Karen B Lasater  1 , Douglas M Sloane  2 , Matthew D McHugh  3 , Jeannie P Cimiotti  4 , Kathryn A Riman  3 , Brendan Martin  5 , Maryann Alexander  5 , Linda H Aiken  3
Affiliations

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

Karen B Lasater et al. Am J Infect Control. 2021 Jul.

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.

Keywords: Acute care; Health services research; Nursing.

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Conflict of interest statement

Conflicts of Interest: None to declare.

References

    1. New York State Department of Health. Rory’s Regulations https://www.health.ny.gov/facilities/public_health_and_health_planning_c....
    1. Centers for Medicare & Medicaid. Severe Sepsis and Septic Shock: Management Bundle (Composite Measure). https://cmit.cms.gov/CMIT_public/ViewMeasure?MeasureId=1017.
    1. Singer M et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 315, 801–810 (2016). - PMC - PubMed
    1. Barbash IJ, Davis B & Kahn JM National performance on the Medicare SEP-1 sepsis quality measure. Crit. Care Med. 47, 1026–1032 (2019). - PMC - PubMed
    1. Centers for Medicare & Medicaid. Hospital Compare. https://www.medicare.gov/hospitalcompare/search.html.

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