Observational studyBMJ open2023
Staffing levels and hospital mortality in England: a national panel study using routinely collected data.
Observational study in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04374812 (Consequences, Costs and Cost-effectiveness of Different Workforce Configurations in English Acute Hospitals), which is not on this map. Cited by 7 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
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.
Consequences, Costs and Cost-effectiveness of Different Workforce Configurations in English Acute Hospitals: a Longitudinal Retrospective Study Using Routinely Collected Data
Who cites it
7 citing papers in PubMed.
- Unravelling the conceptualisation of unfinished care among physicians in acute care hospitals: a scoping review.BMJ open · 2025Article
- Care Left Undone Among Physicians: An Explorative Thematic Analysis.BMJ open quality · 2025Article
- Operationalising routinely collected patient data in research to further the pursuit of social justice and health equity: a team-based scoping review.BMC medical research methodology · 2025Article
- Retaining doctors in emergency medicine: an ethnographic study of emergency departments in England.BMJ open · 2024Article
- Nurse understaffing associated with adverse outcomes for surgical admissions.The British journal of surgery · 2024Article
- Hospital personnel perspectives on factors influencing acute care patient outcomes: a qualitative approach to model refinement.BMC health services research · 2024Article
- The relationship between staffing and adverse events in Washington State hospitals: a cross-sectional study using linked hospital data.Research square · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
Abstract
objectivesExamine the association between multiple clinical staff levels and case-mix adjusted patient mortality in English hospitals. Most studies investigating the association between hospital staffing levels and mortality have focused on single professional groups, in particular nursing. However, single staff group studies might overestimate effects or neglect important contributions to patient safety from other staff groups.
designRetrospective observational study of routinely available data. SETTING AND
participants138 National Health Service hospital trusts that provided general acute adult services in England between 2015 and 2019. OUTCOME MEASURE: Standardised mortality rates were derived from the Summary Hospital level Mortality Indicator data set, with observed deaths as outcome in our models and expected deaths as offset. Staffing levels were calculated as the ratio of occupied beds per staff group. We developed negative binomial random-effects models with trust as random effects.
resultsHospitals with lower levels of medical and allied healthcare professional (AHP) staff (e.g, occupational therapy, physiotherapy, radiography, speech and language therapy) had significantly higher mortality rates (rate ratio: 1.04, 95% CI 1.02 to 1.06, and 1.04, 95% CI 1.02 to 1.06, respectively), while those with lower support staff had lower mortality rates (0.85, 95% CI 0.79 to 0.91 for nurse support, and 1.00, 95% CI 0.99 to 1.00 for AHP support). Estimates of the association between staffing levels and mortality were stronger between-hospitals than within-hospitals, which were not statistically significant in a within-between random effects model.
conclusionsIn additional to medicine and nursing, AHP staffing levels may influence hospital mortality rates. Considering multiple staff groups simultaneously when examining the association between hospital mortality and clinical staffing levels is crucial. TRIAL REGISTRATION NUMBER: NCT04374812.
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