Hospital staffing levels affect death rates
Fewer patients die after emergency surgery in hospitals that have more doctors and nurses.
The findings stood despite patients at these hospitals being sicker and suffering more complications.
Researchers also found death was more likely following a weekend admission, which they said showed staffing was factor in the so called weekend effect.
That is the term given to the on going debate about Saturday and Sunday services.
Ministers in England are looking to improve staffing levels on the weekend, citing previous research as the basis for their policy.
Higher rates of death following weekend admissions and among babies born at weekends have been identified in two papers published by the British Medical Journal since the summer.
While this study confirms what would be expected – better resourced hospitals provide better care – it is this link with weekend care that has sparked interest.
The St George’s University of London team looked at what factors were behind variation in death rates following emergency abdominal surgery at 156 NHS trusts between 2005 and 2010.
This included surgery on ulcers, to remove appendixes and repair hernias.
While only a small number died within 30 days – just over 12,000 patients – there were small but significant variations in the death rates between those hospitals with the highest level of staffing and those with the lowest.
The third of hospitals with the lowest number of doctors per bed had death rates 7% higher than the third with the most. The difference was the same for nurse staffing levels.
Weekend admissions for emergency surgery led to an 11% increased risk in death compared with weekdays.
Lead researcher Dr Peter Holt said it was likely there would be a number of factors behind the higher death rates at weekends, but “clearly” staffing was one. “We need to ensure the whole system is safe seven days a week,” he said.
But he added the government needed to focus on getting emergency care right before even thinking about non-urgent services.
Royal College of Nursing general secretary Janet Davies said the study highlighted the importance of supporting “hard-working” staff.
“The NHS could reduce its staff turnover and save on the cost of temporary staff if it valued and invested in its permanent staff,” she said. “The benefits for all – staff, patients, and the NHS itself would be immeasurable.”
Health Direct praises hard working doctors and nurses in the NHS- but points out the current discussions on junior doctors is just one aspect of increased effectiveness- 7 day week diagnostics and consultants also needs to be addressed.
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