Workforce Hospital Outcomes (in English Acute Hospitals)

NCT04374812 | Completed

• 2 other identifiers: NIHR12805652957.A1
• Study Type: observational
• Target: 1,706,388
• Locations: 1 country
• Sites: 1

Brief Summary

Background: The NHS is facing significant challenges in recruiting and retaining staff, particularly registered nurses (RNs). Recruiting unregistered staff is often adopted as a solution to the RN shortage; however recent research found a negative effect of low RN staffing levels on mortality with no evidence that high levels of assistant staff could mitigate the increased risk. Economic modelling suggested that increases in skill mix were potentially cost-effective, but these findings derive from a single NHS hospital Trust with limited cost and outcome data. Aims and objectives: This project aims to estimate the consequences, costs and cost effectiveness of variation in the size and composition of the staff on hospital wards in England. In order to provide estimates that are more likely to apply across the NHS, this study will include at least four hospitals and consider a wider range of outcomes and sources of costs, including death within 30 days of admission, adverse events such as infections, length of hospital stay, readmissions and rates of staff sickness. Methods: This retrospective longitudinal observational study will use routinely collected data on ward and shift level nurse staffing, and patient outcomes. Data will be derived from the E-Roster systems, used by hospitals to record all planned and worked shifts. The investigators will consider all rostered direct care staff. These data will be linked to patient data derived from the hospital patient administration system (PAS); and other clinical systems and databases of adverse events (e.g. datix). Relationships between RN and assistant staffing levels and outcomes will be explored using survival models incorporating mixed effects. The investigators will use the results of these analyses to model the costs and consequences of different staffing configurations and to estimate the incremental cost-effectiveness associated with change. Our study will provide evidence to inform staffing levels and skill mix planning in the NHS, highlighting potential cost savings, and offering improved patient safety and reduced adverse staff outcomes.

Conditions

Health Workforce

Keywords

health workforce; outcome measures

Outcome Measures

Primary Outcomes (1)

• Patient deaths

  Adjusted hazard ratio for death from all causes within 30 days of hospital admission

  30 days

Interventions

Exposure to registered nurses OTHER

Change in outcomes associated with a one hour per patient day increase in exposure to registered nurses

Also known as: RN staffing level

Exposure to nursing assistants OTHER

Change in outcomes associated with a one hour per patient day increase in exposure to nursing assistants

Also known as: HCA or NA staffing levels

Eligibility Criteria

• Sex: all
• Healthy Volunteers: No
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Patients staying on inpatient wards in acute hospital Trusts in England

Eligibility criteria for hospitals: * acute hospital Trust in England * willingness and ability to provide anonymised patient data and the ability to provide electronic roster data for a minimum period of 1 year prior to the commencement of the study. Eligibility criteria for patients: * stayed on at least one acute inpatient ward / admissions unit (including High Dependency Unit and Intensive Care Unit) during the study period.

Contact the study team to discuss eligibility requirements. They can help determine if this study is right for you.

Sponsors & Collaborators

• University of Southampton: lead

Study Sites (1)

Hospital Trust A

London, United Kingdom

Location

Related Publications (3)

• Griffiths P, Saville C, Ball J, Culliford D, Jones J, Lambert F, Meredith P, Rubbo B, Turner L, Dall'Ora C. Consequences, costs and cost-effectiveness of workforce configurations in English acute hospitals. Health Soc Care Deliv Res. 2025 Jul;13(25):1-107. doi: 10.3310/ZBAR9152.

  PMID: 40622683 DERIVED

• Meredith P, Turner L, Saville C, Griffiths P. Nurse understaffing associated with adverse outcomes for surgical admissions. Br J Surg. 2024 Aug 30;111(9):znae215. doi: 10.1093/bjs/znae215.

  PMID: 39313222 DERIVED

• Rubbo B, Saville C, Dall'Ora C, Turner L, Jones J, Ball J, Culliford D, Griffiths P. Staffing levels and hospital mortality in England: a national panel study using routinely collected data. BMJ Open. 2023 May 17;13(5):e066702. doi: 10.1136/bmjopen-2022-066702.

  PMID: 37197808 DERIVED

Study Officials

• Peter Griffiths

  The University of Southampton

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: April 20, 2020
• First Posted: May 5, 2020
• Study Start: September 21, 2020
• Primary Completion: April 30, 2022
• Study Completion: June 30, 2022
• Last Updated: May 31, 2023

Record last verified: 2023-05

Data Sharing

• IPD Sharing: Will not share

Locations

GB (1)