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Medication Safety Officers Society 4282 Members Strong A society of healthcare professionals dedicated to improving medication safety in healthcare organizations |
More than 20 years since a landmark study1 documented hospitalised patients were more likely to die when their nurse cared for too many patients at a time, hundreds of rigorously conducted studies in over 30 countries have documented a relationship between nurse understaffing and poorer outcomes of all kinds, including preventable patient deaths and avoidable burnout of nurses.2–4 Despite the empirical evidence, chronic hospital nurse understaffing persists.
Why has the research evidence not substantively transformed hospital staffing practices? One possible explanation is that the benefits of eliminating nurse understaffing accrue to patients and nurses, while the costs of staffing more nurses accrue to hospitals.
Hospitals are the most expensive healthcare setting, largely because of the intensive nursing care that hospitalised patients require. Indeed, if patients can have procedures and treatments administered outside of hospitals (eg, outpatient offices, home care), they do,...
BMJ is concerned about the consent obtained from veterans to use their personal information in this research paper1 and broader Veterans' Medicines Advice and Therapeutics Education Services (MATES) program. BMJ was contacted by veterans who asked the journal to retract the content on this basis.
The MATES program was operated by the Department for Veterans Affairs (DVA), and the research was conducted by the University of South Australia (UniSA).2 DVA was responsible for obtaining consent from the veterans to use their personal information in the MATES program; they were also responsible for managing opt-out requests.
In 2018, a veteran lodged a complaint with the Australian Information and Privacy Commissioner about the validity of consent for DVA’s collection and use of their personal information in the MATES programme. In 2023, the Privacy Commissioner determined that DVA had breached an Australian privacy principle by using and disclosing...
Since the 18th century, bedside rounds have been a fundamental component of clinical care, serving as a setting where clinical information is gathered, processed and shared.1 This tradition highlights the importance of maintaining a high level of structure during clinical encounters. Over time, structured tools to guide care have been widely adopted across multiple specialties.2–6 Systematic checklists, in particular, have become the most used form of structured intervention in bedside wards to enhance patient care and safety.7–9 This intervention has been associated with improved non-clinical outcomes, such as communication and adherence to standard protocols.7–9 However, their impact on clinical outcomes remains a matter of debate.10
A 2014 systematic review found that safety checklists improved team communication, improved adherence to standards and reduced adverse...
Understaffing by nursing staff in hospitals is linked to patients coming to harm and dying unnecessarily. There is a vicious cycle whereby poor work conditions, including understaffing, can lead to nursing vacancies, which in turn leads to further understaffing. Is hospital investment in nursing staff, to eliminate understaffing on wards, cost-effective?
MethodsThis longitudinal observational study analysed data on 185 adult acute units in four hospital Trusts in England over a 5-year period. We modelled the association between a patient’s exposure to ward nurse understaffing (days where staffing was below the ward mean) over the first 5 days of stay and risk of death, risk of readmission and length of stay, using survival analysis and linear mixed models. We estimated the incremental cost-effectiveness of eliminating understaffing by registered nurses (RN) and nursing support (NS) staff, estimating net costs per quality-adjusted life year (QALY). We took a hospital cost perspective.
FindingsExposure to RN understaffing is associated with increased hazard of death (adjusted HR (aHR) 1.079, 95% CI 1.070 to 1.089), increased chance of readmission (aHR 1.010, 95% CI 1.005 to 1.016) and increased length of stay (ratio 1.687, 95% CI 1.666 to 1.707), while exposure to NS understaffing is associated with smaller increases in hazard of death (aHR 1.072, 95% CI 1.062 to 1.081) and length of stay (ratio 1.608, 95% CI 1.589 to 1.627) but reduced readmissions (aHR 0.994, 95% CI 0.988 to 0.999). Eliminating both RN and NS understaffing is estimated to cost £2778 per QALY (staff costs only), £2685 (including benefits of reduced staff sickness and readmissions) or save £4728 (including benefits of reduced lengths of stay). Using agency staff to eliminate understaffing is less cost-effective and would save fewer lives than using permanent members of staff. Targeting specific patient groups with improved staffing would save fewer lives and, in the scenarios tested, cost more per QALY than eliminating all understaffing.
InterpretationRectifying understaffing on inpatient wards is crucial to reduce length of stay, readmissions and deaths. According to the National Institute for Health and Care Excellence £10 000 per QALY threshold, it is cost-effective to eliminate understaffing by nursing staff. This research points towards investing in RNs over NS staff and permanent over temporary workers. Targeting particular patient groups would benefit fewer patients and is less cost-effective.
In the intensive care unit (ICU), antibiotics are often given longer than recommended in guidelines. A better understanding of the factors influencing antibiotic therapy duration is needed to develop improvement strategies to effectively address these drivers of excessive duration. This study aimed to explore the determinants of adherence to recommended antibiotic therapy durations among healthcare professionals involved in antibiotic decision-making within the ICU, focusing on multidisciplinary meetings (MDMs).
MethodsSemistructured interviews were held with healthcare professionals involved in antibiotic decision-making during MDMs in four Dutch ICUs. Participants included intensivists, clinical microbiologists and ICU residents. Transcripts were analysed using deductive and inductive content analysis methods.
ResultsA total of 20 participants were interviewed. The interviews revealed that decision-making regarding antibiotic therapy duration is a complex process, primarily centred around professional interactions during MDMs and involving a broad range of determinants. These determinants were categorised into the following four steps: (1) the introduction of duration as a topic for discussion in the MDM (eg, lack of priority to discuss antibiotic therapy duration); (2) the discussion of antibiotic therapy duration itself (eg, lack of core members during MDM); (3) the establishment of a concrete decision (eg, lack of documentation of the decisions made); (4) the execution of the decision (eg, forgetting to stop antibiotics).
ConclusionsOur study identified numerous factors that influence decisions about the duration of antibiotic therapy during MDMs in the ICU. By describing these factors throughout the decision-making process, we provided valuable insights into barriers that commonly arise in specific steps, highlighting critical areas for improvement. Daily MDMs were deemed essential for informed decision-making regarding antibiotic therapy duration by the interviewees. Strategies to improve appropriate duration in the ICU should prioritise strengthening interdisciplinary communication between healthcare professionals and adding structure to these meetings.
