Stefan Johansson
8th May 2007, 16:24
Leading article - May 2007
The Leading article for May 2007 is an article about nurse staffing in relation to mortality in neonatal care. The article is written by a research group led by Karen Hamilton at the National Perinatal Epidemiology Unit, Oxford, UK.
The article is published in collaboration with the journal Archives of Disease in Childhood (http://adc.bmj.com/).
The abstract is published below and you can read the complete article here (http://fn.bmj.com/cgi/content/full/92/2/F99).
Permission to publish the abstract has been given by Archives of Disease in Childhood.
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Nurse staffing in relation to risk-adjusted mortality in neonatal care
Karen E StC Hamilton, Margaret E Redshaw and William Tarnow-Mordi
National Perinatal Epidemiology Unit, University of Oxford, UK
University of Sydney, Westmead Hospital and The Children’s Hospital at Westmead, Sydney, Australia
Objective
To assess whether risk-adjusted mortality in very low birthweight or preterm infants is associated with levels of nursing provision.
Design
Prospective study of risk-adjusted mortality in infants admitted to a random sample of neonatal units.
Setting
Fifty four UK neonatal intensive care units stratified by: patient volume; consultant availability; nurse:cot ratios.
Patients
A group of 2585 very low birthweight (birthweight <1500 g) or preterm (<31 weeks gestation) infants.
Main Outcome Measure
Death before discharge or planned deaths at home, excluding lethal malformations, after adjusting for initial risk 12 hours after birth using gestation at birth and measures of illness severity in relation to nursing provision calculated for each baby’s neonatal unit stay.
Results
A total of 57% of nursing shifts were understaffed, with greater shortages at weekends. Risk-adjusted mortality was inversely related to the provision of nurses with specialist neonatal qualifications (OR 0.67; 95% CI 0.42 to 0.97). Increasing the ratio of nurses with neonatal qualifications to intensive care and high dependency infants to 1:1 was associated with a decrease in risk-adjusted mortality of 48% (OR: 0.52, 95% CI: 0.33, 0.83).
Conclusions
Risk-adjusted mortality did not differ across neonatal units. However, survival in neonatal care for very low birthweight or preterm infants was related to proportion of nurses with neonatal qualifications per shift. The findings could be used to support specific standards of specialist nursing provision in neonatal and other areas of intensive and high dependency care.
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You may comment the article directly below or discuss staffing and related issues in the forum Education, Organisation and Evaluation (http://www.99nicu.org/forum/forumdisplay.php?f=15).
The Leading article for May 2007 is an article about nurse staffing in relation to mortality in neonatal care. The article is written by a research group led by Karen Hamilton at the National Perinatal Epidemiology Unit, Oxford, UK.
The article is published in collaboration with the journal Archives of Disease in Childhood (http://adc.bmj.com/).
The abstract is published below and you can read the complete article here (http://fn.bmj.com/cgi/content/full/92/2/F99).
Permission to publish the abstract has been given by Archives of Disease in Childhood.
* * * * * * * * * * * * * * * * * * *
Nurse staffing in relation to risk-adjusted mortality in neonatal care
Karen E StC Hamilton, Margaret E Redshaw and William Tarnow-Mordi
National Perinatal Epidemiology Unit, University of Oxford, UK
University of Sydney, Westmead Hospital and The Children’s Hospital at Westmead, Sydney, Australia
Objective
To assess whether risk-adjusted mortality in very low birthweight or preterm infants is associated with levels of nursing provision.
Design
Prospective study of risk-adjusted mortality in infants admitted to a random sample of neonatal units.
Setting
Fifty four UK neonatal intensive care units stratified by: patient volume; consultant availability; nurse:cot ratios.
Patients
A group of 2585 very low birthweight (birthweight <1500 g) or preterm (<31 weeks gestation) infants.
Main Outcome Measure
Death before discharge or planned deaths at home, excluding lethal malformations, after adjusting for initial risk 12 hours after birth using gestation at birth and measures of illness severity in relation to nursing provision calculated for each baby’s neonatal unit stay.
Results
A total of 57% of nursing shifts were understaffed, with greater shortages at weekends. Risk-adjusted mortality was inversely related to the provision of nurses with specialist neonatal qualifications (OR 0.67; 95% CI 0.42 to 0.97). Increasing the ratio of nurses with neonatal qualifications to intensive care and high dependency infants to 1:1 was associated with a decrease in risk-adjusted mortality of 48% (OR: 0.52, 95% CI: 0.33, 0.83).
Conclusions
Risk-adjusted mortality did not differ across neonatal units. However, survival in neonatal care for very low birthweight or preterm infants was related to proportion of nurses with neonatal qualifications per shift. The findings could be used to support specific standards of specialist nursing provision in neonatal and other areas of intensive and high dependency care.
* * * * * * * * * * * * * * * * * * *
You may comment the article directly below or discuss staffing and related issues in the forum Education, Organisation and Evaluation (http://www.99nicu.org/forum/forumdisplay.php?f=15).