Hospital death rates affected by staffing levels

A study, published in the British Journal of Anaesthesia, has suggested that fewer patients undergoing emergency surgery die in hospitals that have higher staffing levels.

The research, which analysed data relating to nearly 295,000 patients, also found that patients were more likely to die after a weekend admission. They said this showed that staffing had an influence on the ‘weekend effect’, which is the phrase given to the debate on Saturday and Sunday services.

The research team, based at St George’s University of London, looked into factors surrounding variation in death rates at 156 NHS trusts between 2005 and 2010 following emergency abdominal surgery, including appendectomies, hernia repairs and surgery on ulcers.

Although the number of patients that died within 30 days was small (just over 12,000) the variation between hospitals with the highest level of staffing and hospitals with the lowest, was small but considerable.

Death rates were 7% higher at hospitals with the lowest number of doctors for each bed than the hospitals with the highest, with the difference being the same for nursing levels. Emergency surgery performed at weekends led to an 11% increased risk of death when compared with surgery performed during the week.

Dr Peter Holt, lead researcher, said that although there were a number of factors linked to the higher death rates at weekends, “clearly” one influence was staffing. He said “We need to ensure the whole system is safe seven days a week.”

Janet Davies, general secretary of the Royal College of Nursing, said “The NHS could reduce its staff turnover and save on the cost of temporary staff if it valued and invested in its permanent staff.

“The benefits for all – staff, patients, and the NHS itself would be immeasurable.”

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Posted by Tony May, Partner/head of Clinical Negligence Department, Chadwick Lawrence LLP (tonymay@chadlaw.co.uk ), medical lawyers and clinical negligence solicitors in Huddersfield, Leeds, Wakefield and Halifax, West Yorkshire.

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