Study: Inadequate RN staffing raises patient mortality, costs

Editor's Note

Short-staffed hospital wards face higher patient mortality, readmissions, and lengthier stays—especially when they rely on temporary staff instead of permanent registered nurses, according to research published in BMJ Quality & Safety. 

As detailed in a summary from Medscape News UK, the large-scale, longitudinal observational study was led by the University of Southampton and funded by the National Institute for Health and Care Research.Researchers assessed over 626,000 patients across 185 acute care wards in four NHS hospital trusts in England, using data from 2015 to 2020. Findings linked lower RN staffing levels with worse patient outcomes: wards understaffed with RNs saw a 5% mortality rate versus 4% on adequately staffed units. Similarly, readmission rates increased from 14% to 15%, and average hospital stays rose from 5 to 8 days.

The outlet reports that even a single day of RN understaffing during the first five days of a patient’s stay increased the 30-day mortality risk by 8%, readmission risk by 1%, and extended the average stay by nearly 70% if all five days were understaffed. Similar patterns emerged with understaffed support roles, though the impact was slightly less pronounced.

Researchers also found that while addressing these gaps would require an additional £197 per patient admission, it could prevent over 6,500 deaths and yield 44,483 extra years of good health, Medscape reports. The cost per quality-adjusted life year (QALY) gained came out to £2,778—well below the UK’s accepted cost-effectiveness threshold—and dropped further when factoring in lower sick leave and readmissions. When accounting for shorter hospital stays, eliminating RN understaffing became cost-saving, generating £4,728 in net savings per healthy year of life gained.

Attempts to fill gaps with temporary staff were significantly more expensive and less effective, the outlet reports, with the cost per healthy life year gained ranging betweent £7,320 and £14,639 in those cases. The researchers concluded that permanent RNs should be prioritized over support staff for improving patient outcomes and that relying on temporary coverage “is more costly and less effective.”