Health
Shortage of staff in surgical wards leads to negative impacts
New Paper British Journal of SurgeryA study published by Oxford University Press found that nursing shortages lead to longer hospital stays and worse patient outcomes, including higher mortality rates.
Physicians perform more than 300 million surgeries worldwide each year. Observers have expressed concerns about the quality of care for adult patients undergoing surgery, as well as the rising costs of avoidable complications, longer hospital stays, and readmissions. Approximately 55% of surgical site infections are preventable.
To date, safety measures to address this issue have focused primarily on implementing checklists, training staff, and improving teamwork. However, staff shortages alone may be a significant cause of post-operative infections and other adverse outcomes. Nurses play a key role in keeping surgical patients safe and healthy. Staffing shortages of both registered nurses and nursing assistants have been associated with an increased risk of a range of adverse events.
A recent review of 44 studies found that higher levels of nurse staffing were associated with lower 30-day mortality in surgical patients. However, most studies focused on hospital-level staffing rather than actual surgical wards. In this new paper, researchers from the University of Southampton used surgical patient and staffing data for 213,910 admissions across four National Health Service England hospitals to examine outcomes between April 2015 and February 2020.
In situations where a unit had below-average staffing levels, the researchers found that a nursing shortage increased the relative risk of readmission by 2.3% (and 1.4% for nursing assistant shortages). The study showed that a nursing shortage was associated with a 4.8% increase in readmissions. Deep vein thrombosisPneumonia increased by 5.7% and pressure ulcers increased by 6.4%.
Days with low registered nurse staffing levels were associated with a 9.2% increased relative risk of mortality, and days with low nursing assistant staffing levels were associated with a 10.3% increased relative risk of mortality.
The safety of surgical patients is paramount, so having the right systems, policies and procedures in place is obviously key.”
Paul Meredith, University of Southampton
“This study is a timely reminder that workload is also a significant factor in risk and that the risk to patients undergoing surgery extends beyond the immediate post-operative period. Having enough nurses on wards is essential to ensure the safety of patients undergoing surgery and those recovering after surgery.”
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