Stroke patients admitted to specialized units on the weekend have better outcomes when there is a higher registered nurse-to-bed ratio, according to a study published Aug. 19 in PLOS Medicine.
The research team, led by Benjamin D. Bray, MRCP, of King’s College London and the Royal College of Physicians in the United Kingdom, investigated claims that mortality rates were higher for patients admitted over the weekend. They used data provided to two datasets on stroke care in England, one relating to administrative data and the other involving patient characteristics and processes of care. The analysis involved 103 stroke units, encompassing 56,666 stroke patients.
Nurse staffing was only one variable the team explored. Bray et al also looked into the relationship between the number of days per week rounds occurred with stroke specialist physicians and mortality outcomes.
They found that there was no significant difference in stroke unit mortality outcomes when stroke specialist physicians did rounds fewer than seven days a week. However, there was a significant difference in outcomes dependent on nurse staffing. Where there were 1.5 nurses per 10 beds, there was an equivalent of one excess death per 25 admissions compared to units where there were three or more nurses per 10 beds.
Stroke units where fewer than 1.5 nurses per 10 beds on the weekend had seven-day mortality rates of 7.1 percent, 30-day mortality rates of 14.6 percent and 90-day mortality rates of 20.3 percent. There were similar rates seen in stroke units where nurse staffing on weekends ranged from 2.9 nurses down to 1.5 nurses per 10 hospital beds.
Units where weekend staffing had three nurses or more per 10 beds had a seven-day mortality rate of 4.5 percent, 30-day mortality rate of 10.2 percent and a 90-day mortality rate of 15.5 percent.
Bray et al noted that while staffing was expensive, these data suggest higher weekend registered nurse-to-bed ratios in stroke units for better outcomes. They wrote that further research was needed to study different models of physician-nursing staffing to impact outcomes in the most positive way possible.