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A comparison of in-hospital mortality risk conferred by high hospital occupancy, differences in nurse staffing levels, weekend admission, and seasonal influenza.

Abstract：

BACKGROUND:Hospital occupancy, nurse staffing levels, weekend admission, and seasonal influenza have all been shown to be associated with in-hospital mortality. Yet, no study has simultaneously compared the strength of associations of these 4 factors with in-hospital mortality. OBJECTIVE:To compare the risk of in-hospital mortality conferred by high hospital occupancy on admission, increased nurse staffing levels, weekend admission, and seasonal influenza. STUDY DESIGN:Retrospective cohort study of 166,920 patients admitted to 39 Michigan hospitals between 2003 and 2006. Participants were adults, age > or = 65 years, admitted through the emergency department with 6 common discharge diagnoses (acute myocardial infarction, congestive heart failure, stroke, pneumonia, hip fracture, gastrointestinal bleeding). We used logistic regression to compare the differences in the predicted probability of death conferred by each of the 4 factors, controlling for patient age, gender, discharge diagnosis, and comorbid conditions. RESULTS:Each of the 4 factors had a statistically significant, independent association with in-hospital mortality. Seasonal influenza conferred the greatest increase in absolute risk of in-hospital mortality (0.5 percentage points; 95% CI, 0.23-0.76), followed by weekend admission (0.32, 0.11-0.54), and high hospital occupancy on admission (0.24, 0.06-0.43). Increased nurse staffing levels decreased the absolute risk of mortality by 0.25 percentage points (0.04-0.48) for each additional full-time equivalent nurse per patient-day. CONCLUSION:Hospital occupancy, nurse staffing levels, weekend admission, and seasonal influenza all appear to be independently associated with in-hospital mortality, but to varying degrees in the current sample. These findings may guide hospital administrators as they consider factors that influence weekly and seasonal patient flow and capacity, as well as staffing.

journal_name

Med Care

journal_title

Medical care

authors

Schilling PL,Campbell DA Jr,Englesbe MJ,Davis MM

doi

10.1097/MLR.0b013e3181c162c0

subject

Has Abstract

pub_date

2010-03-01 00:00:00

pages

224-32

issue

eissn

0025-7079

issn

1537-1948

journal_volume

pub_type

杂志文章,多中心研究

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A comparison of in-hospital mortality risk conferred by high hospital occupancy, differences in nurse staffing levels, weekend admission, and seasonal influenza.