Patient Safety and Quality

Study suggests caution in interpreting impact of nurse staffing levels on postsurgical complication rates

For the past few years, hospitals have kept a keen eye on reducing a set of complications that can arise after surgeries, such as pneumonia, septicemia, urinary tract infections, thrombophlebitis, fluid overload, and pressure ulcers. This increased scrutiny is due in part because Medicare does not reimburse hospitals for the costs of treating hospital-acquired complications. In some studies, boosting nurse staffing levels has been shown to improve care safety and quality in many areas. However, a new study, using the present-on-admission indicator to rule out patients who in fact had the condition when they were admitted, found that upping the number of registered nurses (RNs) did not significantly affect postsurgical complication rates.

Barbara A. Mark, Ph.D., R.N., F.A.A.N., of the University of North Carolina, Chapel Hill, and a colleague strongly suggest that hospitals view these results cautiously. One explanation for the results may be that hospitals with ample RNs on staff may be better able to detect and treat complications quickly. Other explanations for the surprising results may be because the researchers' methods relied on administrative data, which can be inaccurately or incompletely coded and there may have been unmeasured aspects of patient risk that were not fully captured.

Given Medicare's new rule, there is likely to be increased demand for RNs to document a complete assessment of patients' clinical status upon admission and nursing workload is likely to increase, note the authors. Their findings were based on analysis of 1996 to 2001 data from 283 acute care hospitals in California. The study was funded in part by the Agency for Healthcare Research and Quality (HS10153).

See "Nurse staffing and post-surgical complications using the present on admission indicator," by Dr. Mark and David W. Harless, Ph.D., in the February 2010 Research in Nursing and Health 33(1), pp. 35-47.

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