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PSNet: Patient Safety Network
Journal Article

Stress on the ward: evidence of safety tipping points in hospitals.

Kuntz L, Mennicken R, Scholtes S. Management Science. 2014;61.

Many studies have pointed to a relationship between nurse staffing ratios and patient safety. This retrospective examination of hospital mortality across multiple sites in Germany found that at high hospital volume, mortality increased for six high-risk conditions drawn from AHRQ Quality Indicators—acute myocardial infarction, heart failure, gastrointestinal hemorrhage, hip replacement, pneumonia, and stroke. This study revealed a tipping point, an occupancy rate of approximately 93% capacity, at which hospital mortality increased. The authors theorize that at high occupancy rates, frontline clinical staff are overworked and thus error-prone, consistent with prior studies on patient-to-nurse ratios. They propose flexible staffing policies in order to improve patient safety. A previous AHRQ WebM&M commentary discusses nurse staffing ratios, including challenges related to costs and and best practices for managing staffing needs.