Dose-response association between nurse staffing and patient outcomes following major cancer surgeries using a nationwide inpatient database in Japan

doi:10.1111/jocn.16075

Observational Study

. 2022 Sep;31(17-18):2562-2573.

doi: 10.1111/jocn.16075. Epub 2021 Oct 24.

Dose-response association between nurse staffing and patient outcomes following major cancer surgeries using a nationwide inpatient database in Japan

Naoki Hirose^{1

2}, Kojiro Morita³, Hiroki Matsui¹, Kiyohide Fushimi⁴, Hideo Yasunaga¹

Affiliations

¹ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
² Global Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
³ Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁴ Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.

PMID: 34693584
DOI: 10.1111/jocn.16075

Observational Study

Dose-response association between nurse staffing and patient outcomes following major cancer surgeries using a nationwide inpatient database in Japan

Naoki Hirose et al. J Clin Nurs. 2022 Sep.

. 2022 Sep;31(17-18):2562-2573.

doi: 10.1111/jocn.16075. Epub 2021 Oct 24.

Authors

Naoki Hirose^{1

2}, Kojiro Morita³, Hiroki Matsui¹, Kiyohide Fushimi⁴, Hideo Yasunaga¹

Affiliations

¹ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
² Global Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
³ Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁴ Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.

PMID: 34693584
DOI: 10.1111/jocn.16075

Abstract

Aims and objectives: To examine the non-linear dose-response associations between nurse staffing levels and patient outcomes using a nationwide inpatient database in Japan.

Background: Previous studies showed that higher nurse staffing levels were associated with better patient outcomes. However, it remains unclear whether there are thresholds for the associations between higher nurse staffing levels and improved patient outcomes.

Designs: Retrospective observational study design following the STROBE guideline.

Methods: We identified all patients aged ≥20 years who underwent one of six major cancer surgeries between July 2010 and March 2018 using data from the Diagnosis Procedure Combination database, a nationwide database for acute-care inpatients in Japan. Restricted cubic spline regression analyses, the statistical method that allows non-linear functional form, were performed with several scenarios of cut-off points to examine the dose-response associations between patient-to-nurse ratio per shift and failure to rescue, 30-day in-hospital mortality and postoperative complications.

Results: Among 645,687 patients, restricted cubic spline regression analyses showed insignificant associations of patient-to-nurse ratio with failure to rescue and 30-day in-hospital mortality with no threshold, but a reverse J-shaped association with postoperative complications with a threshold of patient-to-nurse ratio per shift of 5.4.

Conclusions: In terms of postoperative complications, additional registered nurses were associated with decreased postoperative complications. However, this incremental benefit of additional registered nurses may disappear if hospitals allocate five to six number of registered nurses in general wards.

Relevance to clinical practice: This study suggested that additional registered nurses over one per five to six patients may not bring the incremental benefit to decrease postoperative complications.

Keywords: cancer surgeries; failure to rescue; in-hospital mortality; nurse staffing; postoperative complications.

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References

REFERENCES

1. Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16), 1987-1993. https://doi.org/10.1001/jama.288.16.1987
1. Aiken, L. H., Sloane, D. M., Bruyneel, L., Van Den Heede, K., Griffiths, P., Busse, R., Diomidous, M., Kinnunen, J., Kózka, M., Lesaffre, E., McHugh, M. D., Moreno-Casbas, M. T., Rafferty, A. M., Schwendimann, R., Scott, P. A., Tishelman, C., Van Achterberg, T., & Sermeus, W. (2014). Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study. The Lancet, 383(9931), 1824-1830. https://doi.org/10.1016/S0140-6736(13)62631-8
1. Birkmeyer, J. D., Siewers, A. E., Finlayson, E. V. A., Stukel, T. A., Lucas, F. L., Batista, I., Welch, H. G., & Wennberg, D. E. (2002). Hospital volume and surgical mortality in the United States. New England Journal of Medicine, 346(15), 1128-1137. https://doi.org/10.1056/NEJMsa012337
1. Desquilbet, L., & Mariotti, F. (2010). Dose-response analyses using restricted cubic spline functions in public health research. Statistics in Medicine, 29(9), 1037-1057. https://doi.org/10.1002/sim.3841
1. Griffiths, P., Maruotti, A., Recio Saucedo, A., Redfern, O. C., Ball, J. E., Briggs, J., Dall'Ora, C., Schmidt, P. E., Smith, G. B.; Missed Care Study Group (2019). Nurse staffing, nursing assistants and hospital mortality: Retrospective longitudinal cohort study. BMJ Quality & Safety, 28(8), 609-617. https://doi.org/10.1136/bmjqs-2018-008043

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[1] Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16), 1987-1993. https://doi.org/10.1001/jama.288.16.1987

[2] Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16), 1987-1993. https://doi.org/10.1001/jama.288.16.1987

[3] Aiken, L. H., Sloane, D. M., Bruyneel, L., Van Den Heede, K., Griffiths, P., Busse, R., Diomidous, M., Kinnunen, J., Kózka, M., Lesaffre, E., McHugh, M. D., Moreno-Casbas, M. T., Rafferty, A. M., Schwendimann, R., Scott, P. A., Tishelman, C., Van Achterberg, T., & Sermeus, W. (2014). Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study. The Lancet, 383(9931), 1824-1830. https://doi.org/10.1016/S0140-6736(13)62631-8

[4] Aiken, L. H., Sloane, D. M., Bruyneel, L., Van Den Heede, K., Griffiths, P., Busse, R., Diomidous, M., Kinnunen, J., Kózka, M., Lesaffre, E., McHugh, M. D., Moreno-Casbas, M. T., Rafferty, A. M., Schwendimann, R., Scott, P. A., Tishelman, C., Van Achterberg, T., & Sermeus, W. (2014). Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study. The Lancet, 383(9931), 1824-1830. https://doi.org/10.1016/S0140-6736(13)62631-8

[5] Birkmeyer, J. D., Siewers, A. E., Finlayson, E. V. A., Stukel, T. A., Lucas, F. L., Batista, I., Welch, H. G., & Wennberg, D. E. (2002). Hospital volume and surgical mortality in the United States. New England Journal of Medicine, 346(15), 1128-1137. https://doi.org/10.1056/NEJMsa012337

[6] Birkmeyer, J. D., Siewers, A. E., Finlayson, E. V. A., Stukel, T. A., Lucas, F. L., Batista, I., Welch, H. G., & Wennberg, D. E. (2002). Hospital volume and surgical mortality in the United States. New England Journal of Medicine, 346(15), 1128-1137. https://doi.org/10.1056/NEJMsa012337

[7] Desquilbet, L., & Mariotti, F. (2010). Dose-response analyses using restricted cubic spline functions in public health research. Statistics in Medicine, 29(9), 1037-1057. https://doi.org/10.1002/sim.3841

[8] Desquilbet, L., & Mariotti, F. (2010). Dose-response analyses using restricted cubic spline functions in public health research. Statistics in Medicine, 29(9), 1037-1057. https://doi.org/10.1002/sim.3841

[9] Griffiths, P., Maruotti, A., Recio Saucedo, A., Redfern, O. C., Ball, J. E., Briggs, J., Dall'Ora, C., Schmidt, P. E., Smith, G. B.; Missed Care Study Group (2019). Nurse staffing, nursing assistants and hospital mortality: Retrospective longitudinal cohort study. BMJ Quality & Safety, 28(8), 609-617. https://doi.org/10.1136/bmjqs-2018-008043

[10] Griffiths, P., Maruotti, A., Recio Saucedo, A., Redfern, O. C., Ball, J. E., Briggs, J., Dall'Ora, C., Schmidt, P. E., Smith, G. B.; Missed Care Study Group (2019). Nurse staffing, nursing assistants and hospital mortality: Retrospective longitudinal cohort study. BMJ Quality & Safety, 28(8), 609-617. https://doi.org/10.1136/bmjqs-2018-008043

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Dose-response association between nurse staffing and patient outcomes following major cancer surgeries using a nationwide inpatient database in Japan

Affiliations

Dose-response association between nurse staffing and patient outcomes following major cancer surgeries using a nationwide inpatient database in Japan

Authors

Affiliations

Abstract

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References

REFERENCES

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Full Text Sources

Medical