Abstract:
OBJECTIVE:To determine the association between daily levels of registered nurse (RN) and nursing assistant staffing and hospital mortality. DESIGN:This is a retrospective longitudinal observational study using routinely collected data. We used multilevel/hierarchical mixed-effects regression models to explore the association between patient outcomes and daily variation in RN and nursing assistant staffing, measured as hours per patient per day relative to ward mean. Analyses were controlled for ward and patient risk. PARTICIPANTS:138 133 adult patients spending >1 days on general wards between 1 April 2012 and 31 March 2015. OUTCOMES:In-hospital deaths. RESULTS:Hospital mortality was 4.1%. The hazard of death was increased by 3% for every day a patient experienced RN staffing below ward mean (adjusted HR (aHR) 1.03, 95% CI 1.01 to 1.05). Relative to ward mean, each additional hour of RN care available over the first 5 days of a patient's stay was associated with 3% reduction in the hazard of death (aHR 0.97, 95% CI 0.94 to 1.0). Days where admissions per RN exceeded 125% of the ward mean were associated with an increased hazard of death (aHR 1.05, 95% CI 1.01 1.09). Although low nursing assistant staffing was associated with increases in mortality, high nursing assistant staffing was also associated with increased mortality. CONCLUSION:Lower RN staffing and higher levels of admissions per RN are associated with increased risk of death during an admission to hospital. These findings highlight the possible consequences of reduced nurse staffing and do not give support to policies that encourage the use of nursing assistants to compensate for shortages of RNs.
journal_name
BMJ Qual Safjournal_title
BMJ quality & safetyauthors
Griffiths P,Maruotti A,Recio Saucedo A,Redfern OC,Ball JE,Briggs J,Dall'Ora C,Schmidt PE,Smith GB,Missed Care Study Group.doi
10.1136/bmjqs-2018-008043subject
Has Abstractpub_date
2019-08-01 00:00:00pages
609-617issue
8eissn
2044-5415issn
2044-5423pii
bmjqs-2018-008043journal_volume
28pub_type
杂志文章abstract:BACKGROUND:There is widespread recognition that leadership skills are essential for effective performance in the workplace, but the evidence detailing effective leadership behaviours for surgeons during operations is unclear. DATA SOURCES:Boolean searches of four on-line databases and detailed hand search of relevant ...
journal_title:BMJ quality & safety
pub_type: 杂志文章,评审
doi:10.1136/bmjqs.2010.040295
更新日期:2011-07-01 00:00:00
abstract:BACKGROUND AND OBJECTIVE:Quality of care is considered to be of central importance in healthcare, disability services and rehabilitation. People experiencing disability often access a range of health and social care services; for some, these services are integral parts of daily life. Little research has explored perspe...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2010.042812
更新日期:2011-01-01 00:00:00
abstract::Medical errors continue to occur despite multiple strategies devised for their prevention. Although many safety initiatives lead to improvement, they are often short lived and unsustainable. Our goal was to build a culture of patient safety within a structure that optimised teamwork and ongoing engagement of the healt...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2012-001011
更新日期:2013-05-01 00:00:00
abstract:OBJECTIVES:In order to improve its quality-assurance programme based on ISO 9001, the Central Sterile Supply Department of a public university hospital has performed a prospective risk analysis using the Preliminary Risk Analysis method (PRA). The objectives were the achievement of a global risk mapping related to the ...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2010.048074
更新日期:2011-08-01 00:00:00
abstract::This commentary explores the nature of creating safety in the here-and-now. Creating safety encompasses two dimensions: revisiting specific behaviours by focusing on substandard performance (reflection), and a more broad-ranging attention to everyday behaviours that are taken as given (reflexivity). The piece pays par...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2010.046714
更新日期:2011-04-01 00:00:00
abstract:BACKGROUND:Good outcomes for in-hospital cardiac arrest (IHCA) depend on a skilled resuscitation team, prompt initiation of high-quality cardiopulmonary resuscitation and defibrillation, and organisational structures to support IHCA response. We examined the role of nurses in resuscitation, contrasting higher versus lo...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2019-009487
更新日期:2019-11-01 00:00:00
abstract:INTRODUCTION:Trauma resuscitation is a complex and time-sensitive endeavour with significant risk for error. These errors can manifest from sequential system, team and knowledge-based failures, defined as latent safety threats (LSTs). In situ simulation (ISS) provides a novel prospective approach to recreate clinical s...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2020-011363
更新日期:2020-10-23 00:00:00
abstract:BACKGROUND AND OBJECTIVES:Due to the multitude of questions in the Hospital-Consumer Assessment of Healthcare Providers and Systems (H-CAHPS) survey, it may be difficult to decide where quality improvement efforts should be focused. Our organisation has supplemented the survey with a 'patient complaints' section. The s...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2015-004371
更新日期:2016-10-01 00:00:00
abstract:OBJECTIVE:To describe the development of evidence-based electronic prescribing (e-prescribing) triggers and treatment algorithms for potentially inappropriate medications (PIMs) for older adults. DESIGN:Literature review, expert panel and focus group. SETTING:Primary care with access to e-prescribing systems. PARTIC...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2010.049635
更新日期:2011-10-01 00:00:00
abstract:OBJECTIVES:To synthesise qualitative studies that investigated the experiences of healthcare professionals with using information from patient-reported outcome measures (PROMs) to improve the quality of care. DESIGN:A qualitative systematic review was conducted by searching PubMed, PsycINFO and CINAHL with no time res...
journal_title:BMJ quality & safety
pub_type: 杂志文章,评审
doi:10.1136/bmjqs-2013-002524
更新日期:2014-06-01 00:00:00
abstract:INTRODUCTION:Emergent evidence suggests that patients can identify and report safety issues while in hospital. However, little is known about the best method for collecting information from patients about safety concerns. This study presents an exploratory pilot of three mechanisms for collecting data on safety concern...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2015-004260
更新日期:2017-01-01 00:00:00
abstract:OBJECTIVE:To assess quality of care for children presenting with acute abdominal pain using validated indicators. DESIGN:Audit of care quality for acute abdominal pain according to 21 care quality indicators developed and validated in four stages. SETTING AND PARTICIPANTS:Medical records of children aged 1-15 years r...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2019-010088
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:Human auditing has been the gold standard for evaluating hand hygiene (HH) compliance but is subject to the Hawthorne effect (HE), the change in subjects' behaviour due to their awareness of being observed. For the first time, we used electronic HH monitoring to characterise the duration of the HE on HH even...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2019-010310
更新日期:2020-11-01 00:00:00
abstract:BACKGROUND:Patient safety experts have postulated that increasing patient participation in communications during patient handovers will improve the quality of patient transitions, and that this may reduce hospital readmissions. Choosing strategies that enhance patient safety through improved handovers requires better u...
journal_title:BMJ quality & safety
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjqs-2012-001171
更新日期:2012-12-01 00:00:00
abstract:OBJECTIVE:To examine the association of consultants' experience with mortality by day of the week when elective surgery was performed. DESIGN:Retrospective observational study using English hospital administrative data. SETTING:All acute and specialist English National Health Service (NHS) hospitals carrying out elec...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2015-004105
更新日期:2016-05-01 00:00:00
abstract:BACKGROUND:Patient and family engagement (PFE) in healthcare is an important element of the transforming healthcare system; however, the prevalence of various PFE practices in the USA is not known. OBJECTIVE:We report on a survey of hospitals in the USA regarding their PFE practices during 2013-2014. RESULTS:The resp...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2015-004006
更新日期:2016-03-01 00:00:00
abstract:BACKGROUND:Burnout is widespread among healthcare providers and is associated with adverse safety behaviours, operational and clinical outcomes. Little is known with regard to the explanatory links between burnout and these adverse outcomes. OBJECTIVES:(1) Test the psychometric properties of a brief four-item burnout ...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2014-002831
更新日期:2014-10-01 00:00:00
abstract:INTRODUCTION:Adverse events (AEs) affect 3-12% of hospitalised patients. These are estimates from a labour-intensive chart review process,which is not feasible outside research. Clinical deterioration on the wards triggers a rapid response teams (RRTs) consult and can be used to identify an AE prospectively. OBJECTIVE...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2014-003833
更新日期:2015-12-01 00:00:00
abstract:PURPOSE:To compare the effectiveness of two types of online learning methodologies for improving the patient-safety behaviours mandated in the Joint Commission National Patient Safety Goals (NPSG). METHODS:This randomised controlled trial was conducted in 2010 at Massachusetts General Hospital and Brigham and Women's ...
journal_title:BMJ quality & safety
pub_type: 杂志文章,随机对照试验
doi:10.1136/bmjqs-2011-000702
更新日期:2012-10-01 00:00:00
abstract:OBJECTIVES:To determine whether the items on the Time Out and the Sign Out of the Surgical Safety Checklist are properly checked by operating room (OR) staff and to explore whether the number of checked items is influenced by the severity of the intervention and the use of the checklist as a memory tool during the Time...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2012-001634
更新日期:2013-08-01 00:00:00
abstract:BACKGROUND:Relatively little is known about how scorecards presenting performance indicators influence medication safety. We evaluated the effects of implementing a ward-level medication safety scorecard piloted in two English NHS hospitals and factors influencing these. METHODS:We used a mixed methods, controlled bef...
journal_title:BMJ quality & safety
pub_type: 杂志文章,多中心研究
doi:10.1136/bmjqs-2012-001730
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVE:To determine the quality and diagnostic accuracy of in-hospital adult clinical emergency calls. DESIGN:Prospective observational study. SETTING:Three National Health Service acute hospitals in England. PARTICIPANTS:Adult patients sustaining an in-hospital cardiac arrest (CA) or medical emergency (ME) which...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2011-000319
更新日期:2012-03-01 00:00:00
abstract:BACKGROUND:In an international effort to reduce antibiotic resistance, in part suggested to be the effect of inappropriate antibiotic use, several quality indicators for outpatient antibiotic use have been proposed. In this study, geographical and educational differences in fluoroquinolone prescription in the treatment...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs.2008.028696
更新日期:2011-01-01 00:00:00
abstract:BACKGROUND:Free-text directions generated by prescribers in electronic prescriptions can be difficult for patients to understand due to their variability, complexity and ambiguity. Pharmacy staff are responsible for transcribing these directions so that patients can take their medication as prescribed. However, little ...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2019-010405
更新日期:2020-05-25 00:00:00
abstract::Statistical hypothesis testing involving the comparison of three or more means and/or proportions is a frequent undertaking in medical statistics. For comparison of means, analysis of variance is a common choice and for comparison of proportions, χ(2) tests are common. However, both these approaches have important lim...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2011-000477
更新日期:2012-06-01 00:00:00
abstract:BACKGROUND:In Scotland, the uptake of clinic-based breast (72%) and cervical (77%) screening is higher than home-based colorectal screening (~60%). To inform new approaches to increase uptake of colorectal screening, we compared the perceptions of colorectal screening among women with different screening histories. ME...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2019-009998
更新日期:2020-06-01 00:00:00
abstract:OBJECTIVE:To examine the effectiveness and cost-effectiveness of the community pharmacy New Medicine Service (NMS) at 26 weeks. METHODS:Pragmatic patient-level parallel randomised controlled trial in 46 English community pharmacies. 504 participants aged ≥14, identified in the pharmacy when presenting a prescription f...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2018-009177
更新日期:2020-04-01 00:00:00
abstract:INTRODUCTION:Hip fractures are associated with high rates of morbidity and mortality and their incidence is set to increase. The National Hip Fracture Database and the Best Practice Tariff were introduced with the aim of improving patient care. This complete audit cycle charts the substantial clinical improvements that...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2014-003700
更新日期:2015-08-01 00:00:00
abstract::In a high-reliability organisation (HRO), safety and quality (SQ) is an organisational priority, and all workforce members are engaged, continuously learning and improving their work. To build organisational capacity for SQ work, we have developed a role-tailored capacity-building framework that we are currently emplo...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2016-006240
更新日期:2017-08-01 00:00:00
abstract:BACKGROUND:Under the 'Choosing Wisely' (CW) framework, professional organisations internationally have advocated limiting imaging for asymptomatic patients following curative cancer therapy, based on limited value and high cost. F18-fluorodeoxyglucose (FDG) positron emission tomography-CT (PET/CT) was widely adopted lo...
journal_title:BMJ quality & safety
pub_type: 杂志文章
doi:10.1136/bmjqs-2019-010756
更新日期:2020-05-28 00:00:00