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Nursing surveillance moderates the relationship between staffing levels and pediatric postoperative serious adverse
Terri Voepel-Lewis1, Elsa Pechlavanidis, Constance Burke
1Department of Anesthesiology, University of Michigan Hospital and Health Systems, United States. terriv@umich.edu
Insights
Nurse staffing levels and patient surveillance are crucial for preventing adverse events in pediatric postoperative care. Higher surveillance can mitigate risks, even with lower nurse staffing, highlighting its importance in patient safety.
Area of Science:
- Pediatric postoperative care
- Patient safety systems
- Healthcare quality improvement
Background:
- System factors like insufficient monitoring, surveillance, and nurse staffing can lead to adverse events in hospitalized patients.
- Limited research exists on these factors' impact on postoperative outcomes, especially in pediatrics.
Purpose of the Study:
- To examine the relationship between surveillance, staffing, and serious adverse events in pediatric postoperative general care units.
- To test if staffing moderates patient factors and surveillance, and if surveillance mediates staffing and adverse events.
Main Methods:
- Retrospective case-control study involving children with serious adverse events and matched controls.
- Data collected included demographics, comorbidities, perioperative details, surveillance frequency, and registered nurse hours per patient per shift (staffing).
- Regression models were used to analyze the relationships between variables.
Main Results:
- The event group had lower registered nurse hours per patient per shift (2.99 vs. 3.38) and higher surveillance frequency (4.27 vs. 2.85 assessments/shift) compared to controls.
- Staffing moderated the link between comorbidity and surveillance, with a significant relationship observed at lower staffing levels.
- Surveillance moderated the relationship between staffing and adverse events, showing no association at lower surveillance levels.
Conclusions:
- Nurse staffing levels influence the association between patient factors and surveillance.
- The relationship between staffing and adverse outcomes is dependent on the level of surveillance.
- Enhanced surveillance may improve patient rescue and outcomes, even during periods of reduced nurse staffing.
Background:
Insufficient monitoring, surveillance, and nurse staffing levels are system factors that may contribute to serious adverse events and deterioration in hospitalized patients. Limited data have examined the relationship between these factors and postoperative outcomes, particularly in the pediatric setting.
Objectives:
This retrospective, case-control study examined the relationship between surveillance, staffing, and serious adverse events in children on general care postoperative units. The following hypotheses were tested: (1) the relationship between patient factors and surveillance would be moderated by staffing (i.e., registered nurse hours per patient per shift), and (2) the relationship between staffing and serious adverse events would be mediated by surveillance.
Methods:
With institutional review board approval, children with serious adverse events on a general care unit were identified from institutional event databases, and procedure-matched controls were randomly selected from surgical lists. Demographics, co-morbidities, perioperative information, frequency of postoperative monitoring and assessments (i.e., surveillance), and registered nurse hours per patient per shift (i.e., staffing) were recorded. Regression models were used to test the hypotheses.
Results:
The Event Group included 98 children and the Control Group, 158. Registered nurse hours per patient per shift were lower for the Event Group (2.99 ± 0.59) compared to Controls (3.38 ± 1.23, p=0.002). The number of assessments/shift was higher for the Event Group (4.27 ± 2.8) compared to Controls (2.85 ± 1.9; p<0.001), as was use of continuous pulse oximetry (78% vs. 58%, respectively; p=0.001). Staffing moderated the relationship between comorbidity and surveillance (r(2)=0.192, p<0.001) revealing a significant relationship at lower staffing but not higher. Surveillance did not mediate the relationship between staffing and events, but moderated it (r(2)=0.435; p<0.001) showing no relationship at lower surveillance levels.
Conclusions:
Nurse staffing levels moderated the relationship between patient factors and surveillance demonstrating that this association is dependent on staffing levels. The association between staffing and adverse outcomes was dependent on the level of surveillance. Increased surveillance based on recognition of deterioration may have facilitated rescue of children in this setting, even during times of lower staffing.
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