Paul G. Shekelle, MD, PhD
Note: The Agency for Healthcare Research and Quality reviewed contract deliverables to ensure adherence to contract requirements and quality, and a copyright release was obtained from the Agency for Healthcare Research and Quality before submission of the manuscript.
Disclaimer: All statements expressed in this work are those of the author and should not in any way be construed as official opinions or positions of the RAND Corporation, Veterans Affairs, the Agency for Healthcare Research and Quality, or the U.S. Department of Health and Human Services.
Acknowledgment: The author thanks Robert Kane, MD; Eileen Lake, PhD, RN; Aneesa Motala, BA; Sydne Newberry, PhD; and Roberta Shanman, MLS.
Financial Support: From the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services (contract HHSA-290-2007-10062I).
Potential Conflicts of Interest: Consultancy: ECRI Institute; Employment: Veterans Affairs; Grants/grants pending: Agency for Healthcare Research and Quality, Veterans Affairs, Centers for Medicare & Medicaid Services, National Institute of Nursing Research, Office of the National Coordinator; Royalties: UpToDate. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-2574.
Requests for Single Reprints: Paul G. Shekelle, MD, MPH, RAND Corporation, 1776 Main Street, Santa Monica, CA 90401; e-mail, firstname.lastname@example.org.
Author Contributions: Conception and design: P.G. Shekelle.
Analysis and interpretation of the data: P.G. Shekelle.
Drafting of the article: P.G. Shekelle.
Critical revision of the article for important intellectual content: P.G. Shekelle.
Final approval of the article: P.G. Shekelle.
Obtaining of funding: P.G. Shekelle.
Administrative, technical, or logistic support: P.G. Shekelle.
Collection and assembly of data: P.G. Shekelle.
A small percentage of patients die during hospitalization or shortly thereafter, and it is widely believed that more or better nursing care could prevent some of these deaths. The author systematically reviewed the evidence about nurse staffing ratios and in-hospital death through September 2012. From 550 titles, 87 articles were reviewed and 15 new studies that augmented the 2 existing reviews were selected. The strongest evidence supporting a causal relationship between higher nurse staffing levels and decreased inpatient mortality comes from a longitudinal study in a single hospital that carefully accounted for nurse staffing and patient comorbid conditions and a meta-analysis that found a “dose–response relationship” in observational studies of nurse staffing and death. No studies reported any serious harms associated with an increase in nurse staffing. Limiting any stronger conclusions is the lack of an evaluation of an intervention to increase nurse staffing ratios. The formal costs of increasing the nurse–patient ratio cannot be calculated because there has been no evaluation of an intentional change in nurse staffing to improve patient outcomes.
Hospital organization, nursing organization, and patient outcomes.
From reference 8, with permission.
Pooled odds ratio of quartiles of nurse staffing levels.
Odds ratios are based on pooled analysis consistent across the studies (heterogeneity not significant). From reference 27, with permission. RN = registered nurse.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Shekelle PG. Nurse–Patient Ratios as a Patient Safety Strategy: A Systematic Review. Ann Intern Med. ;158:404–409. doi: 10.7326/0003-4819-158-5-201303051-00007
Download citation file:
Published: Ann Intern Med. 2013;158(5_Part_2):404-409.
Healthcare Delivery and Policy, Hospital Medicine.
Results provided by:
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use