The Safer Nursing Care Tool as a guide to nurse staffing requirements on hospital wards: observational and modelling study

• Published in: Health services and delivery research 2020-03, Vol.8 (16), p.1-162
• Main Authors: Griffiths, Peter, Saville, Christina, Ball, Jane E, Chable, Rosemary, Dimech, Andrew, Jones, Jeremy, Jeffrey, Yvonne, Pattison, Natalie, Saucedo, Alejandra Recio, Sinden, Nicola, Monks, Thomas
• Format: Article
• Language: English
• Subjects: computer simulation; cost savings; costs and cost analysis; health care economics and organizations; hospital information systems; nursing administration research; nursing staff, hospital; operations research; patient safety; personnel staffing and scheduling; quality of health care; validation studies; workload
• ISSN: 2050-4349; 2050-4357
• DOI: 10.3310/hsdr08160

Background: The Safer Nursing Care Tool is a system designed to guide decisions about nurse staffing requirements on hospital wards, in particular the number of nurses to employ (establishment). The Safer Nursing Care Tool is widely used in English hospitals but there is a lack of evidence about how effective and cost-effective nurse staffing tools are at providing the staffing levels needed for safe and quality patient care. Objectives: To determine whether or not the Safer Nursing Care Tool corresponds to professional judgement, to assess a range of options for using the Safer Nursing Care Tool and to model the costs and consequences of various ward staffing policies based on Safer Nursing Care Tool acuity/dependency measure. Design: This was an observational study on medical/surgical wards in four NHS hospital trusts using regression, computer simulations and economic modelling. We compared the effects and costs of a ‘high’ establishment (set to meet demand on 90% of days), the ‘standard’ (mean-based) establishment and a ‘flexible (low)’ establishment (80% of the mean) providing a core staff group that would be sufficient on days of low demand, with flexible staff re-deployed/hired to meet fluctuations in demand. Setting: Medical/surgical wards in four NHS hospital trusts. Main outcome measures: The main outcome measures were professional judgement of staffing adequacy and reports of omissions in care, shifts staffed more than 15% below the measured requirement, cost per patient-day and cost per life saved. Data sources: The data sources were hospital administrative systems, staff reports and national reference costs. Results: In total, 81 wards participated (85% response rate), with data linking Safer Nursing Care Tool ratings and staffing levels for 26,362 wards × days (96% response rate). According to Safer Nursing Care Tool measures, 26% of all ward-days were understaffed by ≥ 15%. Nurses reported that they had enough staff to provide quality care on 78% of shifts. When using the Safer Nursing Care Tool to set establishments, on average 60 days of observation would be needed for a 95% confidence interval spanning 1 whole-time equivalent either side of the mean. Staffing levels below the daily requirement estimated using the Safer Nursing Care Tool were associated with lower odds of nurses reporting ‘enough staff for quality’ and more reports of missed nursing care. However, the relationship was effectively linear, with staffing above the recommended