Nurse staffing levels, missed vital signs observations and mortality in hospital wards

The NHS in England, like many other healthcare systems, is facing intense pressure to maintain the quality and safety of care provided in hospitals at the same or less cost than in previous years. The quality of nursing care - and the potential for inadequate nursing care to do patients great harm - has emerged as a factor in several reports into failings in NHS hospitals.

Recently studies have begun to explore missed nursing care , defined as nursing care that was needed but not done, as a key factor leading to negative patient outcomes. Missed opportunities to observe and act on deterioration of the patient's condition are thought to be important factors in preventable hospital deaths. Previous studies on missed nursing care have relied on nurses to report the care they missed.

This study explored how nurse staffing levels are related to missed or delayed vital signs observation (that is, measurements of blood pressure, pulse and respirations) using direct measures of the timing of observations recorded in a clinical information system.

The study also looks at the relationship between staffing levels and possible consequences of missed observations in terms of cardiac arrest calls, unanticipated admission to intensive care and death and develops economic models of the costs and consequences of changes in staffing.