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Journal Article > Review
Estabrooks CA, Cummings GG, Olivo SA, Squires JE, Giblin C, Simpson N. Qual Saf Health Care. 2009;18:181-188.
Relationships between various staffing models and the quality and safety of care have been reported with regard to nurses, physicians, and pharmacists. Staffing decisions are also a source of debate around the quality of care delivered on weekends and by trainees. This systematic review examined the specific impact of shift length (8 versus 12 hours) on patient and health care provider outcomes. The authors discovered no significant correlations between shift length and measured outcomes, although the methodological quality of the studies was low. Given the increase in shift work in health care, the authors advocate for greater study of these issues and the importance of understanding their context in different clinical settings.
Journal Article > Study
Bell CM, Redelmeier DA. N Engl J Med. 2001;345:663-668.
This study analyzed nearly 4 million consecutive hospital admissions in Ontario, Canada, over a 10-year period to determine whether mortality rates differed on weekends when staffing levels tend to be lower. Investigators discovered higher rates of in-hospital mortality for patients admitted with ruptured aortic aneurysms, acute epiglottitis, and pulmonary embolism. Of the 100 most frequent causes of death, 23 were associated with higher mortality when those patients were admitted on a weekend. While past research suggested that hospitals function less effectively during weekend hours, a notion supported by the Sunday night death of Libby Zion that raised questions about under-supervised residents, this study was the first to confirm the potential impact weekend staffing issues may generate on the quality and safety of inpatient care.