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Ball JE, Bruyneel L, Aiken LH, et al. Int J Nurs Stud. 2018;78:10-15.
Missed nursing care may result from inadequate nurse staffing and explain the relationship between nurse-to-patient ratios and patient outcomes. Research has shown that higher nurse staffing levels are associated with lower inpatient mortality and that reduced staffing increases the risk for postoperative complications. In this study, investigators examined data from more than 400,000 surgical patients from 300 hospitals in 9 countries as well as survey responses from 26,516 nurses. They found a significant association between nurse staffing and missed nursing care with 30-day risk-adjusted postoperative mortality. The authors conclude that measuring missed nursing care may help identify patients at greater risk for adverse outcomes earlier in their course. A past WebM&M commentary highlighted important issues associated with nurse staffing ratios.
Broom MA, Capek AL, Carachi P, et al. Anaesthesia. 2011;66:175-179.
The sterile cockpit rule mandates elimination of nonessential activities during aircraft takeoffs and landings. This study found disturbingly frequent interruptions during analogous phases of anesthesia management, demonstrating the need to develop a similar rule for the operating room.
Eggli Y, Halfon P, Meylan D, et al. Med Care. 2010;48:962-71.
Classic research has demonstrated a link between increased surgical volume and improved patient outcomes at the hospital level. This research has raised interest in systematic referral of certain procedures to specialized centers, and the Leapfrog Group included volume-based referral as one of its recommended safety practices. However, this study finds that the volume–outcome relationship is limited to a few specific surgeries, and that wide overall variation in surgical mortality exists even after controlling for volume. The authors argue that given these findings, systematic volume-based referral is unlikely to improve surgical outcomes.
Sixth Report of Session 2008–09. House of Commons Health Committee. London, England: The Stationery Office; July 3, 2009. Publication HC 151-I.
This government report analyzes the National Health Service's efforts to enhance patient safety and recommends improving certain areas, such as adopting technology, analyzing failure, and ensuring both practitioner education and adequate staffing.
Paoletti X, Marty J. Br J Anaesth. 2007;98:462-9.
This study used a mathematical simulation model to estimate the risk of adverse events due to unavailability of an anesthesiologist to attend to urgent problems. The risk of system failure was significantly higher when one anesthesiologist was required to cover more than two operating rooms and was also increased when multiple lengthy operations took place simultaneously. An Agency for Healthcare Research and Quality (AHRQ) WebM&M commentary discusses a devastating error that occurred when no anesthesiologist was available for an urgent cesarean section.