The AHRQ PSNet Collection comprises an extensive selection of resources relevant to the patient safety community. These resources come in a variety of formats, including literature, research, tools, and Web sites. Resources are identified using the National Library of Medicine’s Medline database, various news and content aggregators, and the expertise of the AHRQ PSNet editorial and technical teams.
Needleman J, Liu J, Shang J, et al. BMJ Qual Saf. 2020;29:10-18.
Prior research has shown that nurse staffing is an important consideration with regard to patient safety. Lower nurse-to-patient ratios are associated with increased mortality and have prompted policies mandating particular nurse staffing ratios, especially in the intensive care unit. To address the criticism that previous studies have compared different institutions with higher nurse staffing to those with lower staffing levels and that there may be other reasons for observed differences in patient outcomes, this study evaluated the relationship between inpatient mortality and exposure to shifts with decreased registered nurse staffing, lower nursing support staffing, and increased patient turnover at three sites within a single academic medical center. Consistent with prior studies, researchers found an association between low nurse and nursing support staffing and increased patient mortality; there was no association between patient turnover and mortality. An accompanying editorial advocates for additional prospective research on interventions put in place to address nurse staffing.
Needleman J, Pearson ML, Upenieks V, et al. Jt Comm J Qual Patient Saf. 2016;42:61-69.
This evaluation of the Transforming Care at the Bedside initiative—a collaborative intended to drive engagement of bedside nurses in enhancing safety through unit-based quality improvement projects—found highly positive perceptions of the program and evidence of widespread implementation of new innovations.
Kim L, Lyder CH, McNeese-Smith D, et al. J Adv Nurs. 2015;71:2490-503.
Researchers searched the term "patient safety" in the nursing literature and found that few articles gave clear explanations of the concept. Using case discussions to illustrate patient safety in practice situations, the authors seek to help nurses understand the concept, empower them to engage in multidisciplinary efforts to improve safety in care environments, and promote measurement of patient safety data.
Needleman J, Buerhaus P, Pankratz S, et al. New Engl J Med. 2011;364:1037-1045.
Several studies have pointed to a relationship between nurse staffing ratios (particularly staffing by RNs) and patient safety. Such studies have influenced public policy. For example, the state of California mandates certain minimum nurse-to-patient ratios in intensive care units and medical–surgical units. However, methodological limitations have led some to question the strength of this association. This study, the most methodologically robust to date, identified a statistically significant relationship between higher RN staffing and lower patient mortality. High patient turnover was also associated with excess mortality. The study is likely to increase the pressure on hospitals to ensure adequate levels of nurse staffing.
Shiotani LM, Parkerton PH, Wenger N, et al. Am J Med. 2008;121:80-5.
This analysis of survey data found that general internists and subspecialists reported increased time spent in direct patient care over the 5-year study period, although work hours differed between male and female physicians.
Bendavid E, Kaganova Y, Needleman J, et al. Am J Med. 2007;120:422-8.
This study analyzed nearly 5 million admissions to determine if patient safety is truly compromised on weekends. Complication rates were determined for specific surgical and obstetric procedures by using the Agency for Healthcare Research and Quality's (AHRQ) Patient Safety Indicators, with extensive adjustment for comorbid conditions and other confounders. Overall complication rates were modestly but significantly increased for some obstetric indicators and for vascular surgical procedures. The study adds to prior research documenting that patients with an acute myocardial infarction, or other conditions requiring urgent treatment, have increased mortality if admitted on a weekend.
Needleman J, Buerhaus P, Stewart M, et al. Health Aff (Millwood). 2006;25:204-11.
The relationship between nurse staffing and the quality and safety of care has been reported. This study compares three strategies of nurse staffing to determine their impact on costs, associated hospital days, adverse outcomes, and deaths. The options included raising the proportion of registered nurses (RNs) without changing total nursing hours, increasing nurse staffing, and a combination of both strategies. Although the change in proportion of RN staffing offered a cost savings, the latter option had the greatest effect on reduction of adverse outcomes and hospital days. However, the savings from these clinical improvements were not offset by the costs of staffing changes. The authors suggest that hospitals and patients likely share different perspectives on the value added by the nurse staffing options discussed, and health care payers may provide the financial incentive to address this gap.
Poulose BK, Ray WA, Arbogast PG, et al. Ann Surg. 2005;241:847-56; discussion 856-60.
Resident work hour limitations have been enforced nationally since 2003 and in New York State since 1998. This study analyzed the impact of those limitations on standardized surgical patient safety indicators in New York teaching hospitals. Results revealed increased rates over time of accidental puncture or laceration and postoperative thromboembolic events, but no change in other measures. The authors conclude that resident work hour restrictions were not associated with significant improvements in surgicial patient safety.
Needleman J, Buerhaus P, Mattke S, et al. N Engl J Med. 2002;346:1715-22.
The relationship between nursing care factors and patient outcomes is explored in this sentinel study. Investigators examined administrative data encompassing more than 6 million medical and surgical hospital discharges to describe the amount of nursing care provided and its impact on six designated complications. Findings suggested better care in association with both a greater number and higher proportion of care hours delivered by registered nurses (RNs). The authors conclude by advocating for continued measurement of the relationship between nursing issues and adverse outcomes as well as hospital leadership and regulation to promote appropriate nursing care for improved patient outcomes.