ArticleBMJ open2022
Hospital nurse staffing and sepsis protocol compliance and outcomes among patients with sepsis in the USA: a multistate cross-sectional analysis.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.
- The Effect of Severe Sepsis and Septic Shock Management Bundle (SEP-1) Compliance and Implementation on Mortality Among Patients With Sepsis : A Systematic Review.Annals of internal medicine · 2025Pooled it
- Communicative Rationality and Clinical Decision-Making: A Habermasian Perspective on the Doctor-Patient Relationship.Journal of evaluation in clinical practice · 2026Review
- Staffing Audit Outcomes Among California Skilled Nursing Facilities, Prior to and After COVID-19-Related Staffing Waivers.Journal of the American Medical Directors Association · 2026Article
- The Impact of Nurse Staffing and Education on 30-Day Mortality Among Patients Hospitalized for Acute Kidney Injury.Research in nursing & health · 2026Article
- ICU-Broncho-Aspiration Protocols Monitoring at an Academic Health Network System.Southern medical journal · 2025Article
- Clinical nurses' knowledge, attitudes and practices regarding incontinence-associated dermatitis: A cross-sectional study from China.PloS one · 2025Article
- Hospital nurse staffing variation and Covid-19 deaths: A cross-sectional study.International journal of nursing studies · 2024Article
- Article
- Carbapenem is not always the best choice in the treatment of septic shock.European journal of medical research · 2023Observational
- Relationship between nurse staffing during labor and cesarean birth rates in U.S. hospitals.Nursing outlookArticle
- The effect of registered nurse staffing and skill mix on length of stay and hospital costs.Nursing outlookArticle
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesSepsis is a serious inflammatory response to infection with a high death rate. Timely and effective treatment may improve sepsis outcomes resulting in mandatory sepsis care protocol adherence reporting. How the impact of patient-to-nurse staffing compares to sepsis protocol compliance and patient outcomes is not well understood. This study aimed to determine the association between hospital sepsis protocol compliance, patient-to-nurse staffing ratios and patient outcomes.
designA cross-sectional study examining hospital nurse staffing, sepsis protocol compliance and sepsis patient outcomes, using linked data from nurse (2015-2016, 2020) and hospital (2017) surveys, and Centers for Medicare and Medicaid Services Hospital Compare (2017) and corresponding MedPAR patient claims.
setting537 hospitals across six US states (California, Florida, Pennsylvania, New York, Illinois and New Jersey).
participants252 699 Medicare inpatients with sepsis present on admission. MEASURES: The explanatory variables are nurse staffing and SEP-1 compliance. Outcomes are mortality (within 30 and 60 days of index admission), readmissions (within 7, 30, and 60 days of discharge), admission to the intensive care unit (ICU) and lengths of stay (LOS).
resultsSepsis protocol compliance and nurse staffing vary widely across hospitals. Each additional patient per nurse was associated with increased odds of 30-day and 60-day mortality (9% (OR 1.09, 95% CI 1.05 to 1.13) and 10% (1.10, 95% CI 1.07 to 1.14)), 7-day, 30-day and 60-day readmission (8% (OR 1.08, 95% CI 1.05 to 1.11, p<0.001), 7% (OR 1.07, 95% CI 1.05 to 1.10, p<0.001), 7% (OR 1.07, 95% CI 1.05 to 1.10, p<0.001)), ICU admission (12% (OR 1.12, 95% CI 1.03 to 1.22, p=0.007)) and increased relative risk of longer LOS (10% (OR 1.10, 95% CI 1.08 to 1.12, p<0.001)). Each 10% increase in sepsis protocol compliance was associated with shorter LOS (2% ([OR 0.98, 95% CI 0.97 to 0.99, p<0.001)) only.
conclusionsOutcomes are more strongly associated with improved nurse staffing than with increased compliance with sepsis protocols.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.