The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units : a systematic review and meta-analysis

摘要

Background: Nurses are pivotal in the provision of high quality care in acute hospitals. The impact that nursing shortages have on the quality of care provided to patients in hospital can have disastrous consequences. In light of this, a review of the evidence on the effect of nurse staffing levels on patient outcomes is urgently required.udAim: To undertake a systematic review examining the association between nurse staffing levels and nurse sensitive patient outcomes in acute specialist units.udMethods: Nine electronic databases were searched for English published papers between 2006 and 2017. The primary outcome was nurse sensitive patient outcomes.udResults: Of 3429 unique articles identified, 35 met the inclusion criteria. All were observational and the majority utilised large administrative databases. Higher staffingudlevels were associated with reduced mortality, mediation errors, ulcers, restraint use, infections, pneumonia, higher aspirin use and a greater number of patients receivingudPCI within 90 minutes. A meta-analysis involving 175 755 patients, from six studies, admitted to ICU and/or cardiac/cardiothoracic units showed that a low nurse-to-patient ratio decreased the risk of in-hospital mortality by 14% (0.86, 95%CI 0.79-0.94). However, the meta-analysis also showed high heterogeneity (I2=86%).udConclusion: Nurse-to-patient ratios influence many patient outcomes, most markedly mortality. More studies need to be conducted on the association of nurse-to-patient ratios with nurse sensitive patient outcomes to offset the paucity and weaknesses of research in this area. This would provide further evidence for recommendations ofudoptimal nurse-to-patient ratios in acute specialist units.