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Do Higher Hospital-wide Nurse Staffing Levels Reduce In-hospital Mortality in Elderly Patients with Hip Fractures: A Pilot Study

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

There is increasing recognition that lower nurse staffing levels are associated with higher morbidity and mortality among medical and surgical patients. The degree to which this applies to elderly patients with hip fractures is unclear.

Questions/purposes

We conducted a pilot study using administrative data as an initial step in investigating the relationship between nurse staffing levels and in-hospital mortality among elderly patients with hip fractures.

Patients and Methods

We retrospectively reviewed administrative data for 13,343 patients 65 years or older with a primary diagnosis of hip fracture admitted to 39 Michigan hospitals between 2003 and 2006. We used logistic regression to calculate the change in predicted probability of in-hospital death conferred by differences in the hospitals’ overall number of full-time equivalent registered nursing staff (FTE-RN) per patient day. Regression models controlled for patient age, gender, and comorbid conditions; hospital characteristics including teaching status, hip fracture volume, and income/racial composition of the hospital’s zip code; and seasonal influenza.

Results

We found an association between hospital-wide nurse staffing levels and in-hospital mortality among patients with hip fractures. The odds of in-hospital mortality decreased by 0.16 for every additional FTE-RN added per patient day, even after controlling for covariates. This association suggests the absolute risk of mortality increases by 0.35 percentage points for every one unit decrease of FTE-RN per patient day, a 16% increase in the risk of death.

Conclusions

Decreased hospital-wide nurse staffing levels are associated with increased in-hospital mortality among patients admitted with hip fractures. These observations indicate the need for further studies to characterize this relationship for staffing of units caring for patients with hip fractures.

Level of Evidence

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Michigan, 2912 Taubman Center, Ann Arbor, MI, 48109-5328, USA

    Peter Schilling MD, MSc, James A. Goulet MD & Paul J. Dougherty MD

Authors
  1. Peter Schilling MD, MSc
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  2. James A. Goulet MD
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  3. Paul J. Dougherty MD
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Corresponding author

Correspondence to Peter Schilling MD, MSc.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

Appendix 1. Results of logistic regression model

Appendix 1. Results of logistic regression model

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Schilling, P., Goulet, J.A. & Dougherty, P.J. Do Higher Hospital-wide Nurse Staffing Levels Reduce In-hospital Mortality in Elderly Patients with Hip Fractures: A Pilot Study. Clin Orthop Relat Res 469, 2932–2940 (2011). https://doi.org/10.1007/s11999-011-1917-8

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  • DOI: https://doi.org/10.1007/s11999-011-1917-8

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