Staffing Issues a Factor in Higher Weekend Hospitalization Mortality Rates

Patients hospitalized on weekends are at a 15 percent higher risk of dying due to issues related to nurse and physician staffing and training, according to a new report. Researchers concluded that “low staffing levels of nurses and physicians significantly impact mortality.” Mortality rates were also higher among patients admitted to the hospital on weekends in hospitals with less experienced staff, such as resident trainees.

The study, which is currently available in provisional form, was conducted by researchers from Tufts Medical Center in Boston who examined data on more than 48 million patients admitted to hospitals for non-elective reasons from January 1, 2003-December 31, 2008.

Researchers found that the overall odds of mortality were higher for patients in hospitals with fewer nurses and staff physicians. Hospitals with more nurses or physicians per hospital bed had a 10 percent lower rate of mortality after a weekend admission. Mortality in hospitals with the highest number of resident trainees was 17 percent higher following a weekend admission, compared with hospitals with no resident trainees.

An INQRI study, “The Effect of Off-peak Hospital Environments on Nurses' Work: an Institutional Ethnography” also revealed the negative impact of weekend and evening admissions on mortality rates. The INQRI study showed that nurses’ “off-peak” work environments play a significant role in the increased patient mortality.

In off-peak environments, nurses have less access to support, work with less supervision, and have strained communication with on-call health care providers, the study found. Researchers identified ways in which nurse administrators can mitigate the possible reasons for these disparities:

• Being conscious of the fact that the majority of hours nurses work are “off-peak” and ensuring that institutions’ efforts and programs include peak and “off-peak” times;
• Knowing that implementing a solution for a problem that occurs during peak hours may unintentionally create a problem for those nurses who work “off-peak” and involving nurses from every shift in planning and evaluating work processes;
• Collecting performance data in a way that allows for comparing that data across days of the week and times (both peak and “off-peak”), rather than aggregating data over 24 hours or over an entire week; and
• Proactively addressing nurse-physician relations in the hospital.

The INQRI grantees were Patti Hamilton and Gretchen Gemeinhardt.