S I Watson1, W Arulampalam2, S Petrou1, N Marlow3, A S Morgan3, E S Draper4, N Modi5. 1. Warwick Medical School, University of Warwick, Coventry, UK. 2. Department of Economics, University of Warwick, Coventry, UK. 3. Academic Neonatology, UCL Institute for Women's Health, London, UK. 4. Department of Health Sciences, University of Leicester, Leicester, UK. 5. Section of Neonatal Medicine, Department of Medicine, Chelsea and Westminster Campus, Imperial College London, London, UK.
Abstract
OBJECTIVE: To estimate the effect of the provision of a one-to-one nurse-to-patient ratio on mortality rates in neonatal intensive care units. DESIGN: A population-based analysis of operational clinical data using an instrumental variable method. SETTING: National Health Service neonatal units in England contributing data to the National Neonatal Research Database at the Neonatal Data Analysis Unit and participating in the Neonatal Economic, Staffing, and Clinical Outcomes Project. PARTICIPANTS: 43 tertiary-level neonatal units observed monthly over the period January 2008 to December 2012. INTERVENTION: Proportion of neonatal intensive care days or proportion of intensive care admissions for which one-to-one nursing was provided. OUTCOMES: Monthly in-hospital intensive care mortality rate. RESULTS: Over the study period, the provision of one-to-one nursing in tertiary neonatal units declined from a median of 9.1% of intensive care days in 2008 to 5.9% in 2012. A 10 percentage point decrease in the proportion of intensive care days on which one-to-one nursing was provided was associated with an increase in the in-hospital mortality rate of 0.6 (95% CI 1.2 to 0.0) deaths per 100 infants receiving neonatal intensive care per month compared with a median monthly mortality rate of 4.5 deaths per 100 infants per month. The results remained robust to sensitivity analyses that varied the estimation sample of units, the choice of instrumental variables, unit classification and the selection of control variables. CONCLUSIONS: Our study suggests that decreases in the provision of one-to-one nursing in tertiary-level neonatal intensive care units increase the in-hospital mortality rate. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
OBJECTIVE: To estimate the effect of the provision of a one-to-one nurse-to-patient ratio on mortality rates in neonatal intensive care units. DESIGN: A population-based analysis of operational clinical data using an instrumental variable method. SETTING: National Health Service neonatal units in England contributing data to the National Neonatal Research Database at the Neonatal Data Analysis Unit and participating in the Neonatal Economic, Staffing, and Clinical Outcomes Project. PARTICIPANTS: 43 tertiary-level neonatal units observed monthly over the period January 2008 to December 2012. INTERVENTION: Proportion of neonatal intensive care days or proportion of intensive care admissions for which one-to-one nursing was provided. OUTCOMES: Monthly in-hospital intensive care mortality rate. RESULTS: Over the study period, the provision of one-to-one nursing in tertiary neonatal units declined from a median of 9.1% of intensive care days in 2008 to 5.9% in 2012. A 10 percentage point decrease in the proportion of intensive care days on which one-to-one nursing was provided was associated with an increase in the in-hospital mortality rate of 0.6 (95% CI 1.2 to 0.0) deaths per 100 infants receiving neonatal intensive care per month compared with a median monthly mortality rate of 4.5 deaths per 100 infants per month. The results remained robust to sensitivity analyses that varied the estimation sample of units, the choice of instrumental variables, unit classification and the selection of control variables. CONCLUSIONS: Our study suggests that decreases in the provision of one-to-one nursing in tertiary-level neonatal intensive care units increase the in-hospital mortality rate. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Entities:
Keywords:
Mortality; Neonatal intensive care unit; Nurse to patient ratio; Nursing
Authors: Heather L Tubbs-Cooley; Constance A Mara; Adam C Carle; Barbara A Mark; Rita H Pickler Journal: JAMA Pediatr Date: 2019-01-01 Impact factor: 16.193
Authors: Daniel S Tawfik; Jochen Profit; Eileen T Lake; Jessica B Liu; Lee M Sanders; Ciaran S Phibbs Journal: Health Serv Res Date: 2019-12-23 Impact factor: 3.402
Authors: Morris Ogero; Philip Ayieko; Boniface Makone; Thomas Julius; Lucas Malla; Jacquie Oliwa; Grace Irimu; Mike English Journal: J Glob Health Date: 2018-06 Impact factor: 4.413
Authors: Kathy Burgoine; Juliet Ikiror; Sylivia Akol; Margaret Kakai; Sara Talyewoya; Alex Sande; Tom Otim; Francis Okello; Adam Hewitt-Smith; Peter Olupot-Olupot Journal: BMJ Glob Health Date: 2018-02-19
Authors: Georgina A V Murphy; David Gathara; Nancy Abuya; Jacintah Mwachiro; Sam Ochola; Robert Ayisi; Mike English Journal: PLoS One Date: 2018-04-27 Impact factor: 3.240