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Decrease in nurse-to-patient ratio increases NICU mortality
Decreasing nurse-to-patient care to a 1:1 ratio in tertiary level neonatal ICUs increased the in-hospital mortality rate, according to recent findings published in Archives of Disease in Childhood – Fetal and Neonatal Edition.
“This study was designed to estimate the effect of one-to-one nursing on the monthly mortality rate in tertiary level neonatal units in England,” Samuel I. Watson, PhD, research fellow in health economics at Warwick Medical School in Coventry, United Kingdom, and colleagues wrote. “We assess whether tertiary level neonatal units that provide a greater proportion of intensive care days with one-to-one nursing have lower mortality rates using a novel statistical analysis to account for unobserved confounding.”
In 2001, the British Association of Perinatal Medicine (BAPM) recommended a 1:1 nurse-to-patient ratio for all infants in NICUs, a 1:2 nurse-to-patient ratio for infants receiving high dependency care, and a 1:4 ratio for infants receiving special care, the researchers wrote. In 2005, BAPM reported that only 2% of NICUs met these recommendations. A systematic review of six studies published between 1990 and 2010 suggested that a higher nurse-to-patient ratio was associated with reduced mortality, adverse events, and nosocomial infection. The researchers of the systematic review, however, concluded that the studies they examined were too heterogeneous to support any specific nurse-to-patient ratio.
To estimate the effect of a 1:1 ratio for nurse-to-patient mortality rates in NICUs, the researchers performed a retrospective, longitudinal, population-based analysis. They examined monthly clinical data using an instrumental variable method at 43 tertiary level National Health Service NICUs in England from 2008 through 2012.
The researchers found that the percentage of days with one-to-one nursing declined from a median of 9.1% of NICU days in 2008 to 5.9% in 2012. One 10-percentage point decline during this period, they wrote, was associated with a rise in in-hospital mortality of 0.6 deaths/100 infants per month.
The results suggested that the decrease in the 1:1 ratio of nurse-to-patient at NICUs increased the in-hospital mortality rate, the researchers wrote.
“The methods utilized in this study enabled us to account for a number of sources of unobserved confounding so that our results can be arguably interpreted as causal effects in the absence of a randomly assigned [nurse-to-patient 1:1 ratio],” Watson and colleagues wrote. “We believe the results in this study provide some evidence in support of a [nurse-to-patient 1:1 ratio] in neonatal intensive care in England, in line with BAPM guidelines, and therefore provide evidence in support of increased nursing labor provision on neonatal units in England.” – by Will Offit
Disclosure: The researchers report no relevant financial disclosures.
