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Table 6 Characteristics of the reviews included for staffing models

From: Evidence from facility level inputs to improve quality of care for maternal and newborn health: interventions and findings

Reviews

Description of included interventions

Type of studies included (no)

Targeted health care providers

Outcome reported

Pooled data (Y/N)

Results

    

Other outcomes

MNCH specific outcomes

  

Butler 2011[53]

Interventions of staffing models, staffing levels, skill mix, grade mix, or qualification mix.

RCT: 08

CBA:5

CCT: 02

Hospital nursing staff and hospital patients in HIC

In-hospital mortality

 

Yes

0.96 (0.59-1.56)

    

Length of stay

  

1.35 lower (1.92-0.78)

    

Readmission

  

1.15 (0.88-1.52)

    

ED within 30 days

  

1.14 (0.79-1.62)

    

Post-discharge admission

  

1.33 (0.93-1.91)

    

ED visit or death

  

1.03 (0.7 - 1.53)

    

Post discharge adverse events

Glycosylated hemoglobin

  

0.5 lower (1.9 lower – 0.9 higher)

     

Medical procedures in labor

 

Reduced (1/1)

     

Length of stay

 

Reduced (1/1)

Hodgekinsons 2011[65]

Interventions of interest included organizational interventions

(e.g. team/modular nursing, primary nursing, hierarchical nursing, care pairs or partner-in-care models) or regulatory interventions

(e.g. staff patient/resident ratios).

ITS: 01

CBA: 01

Nurses and personal care attendants in HIC

• Incidence of pressure ulcers;

 

No

Two studies generally favour the use of primary care

    

• Incidence of falls;

   
    

• Incidence of medication errors and adverse events;

   
    

• Validated quality of life measurements.

   
    

• Days/hours lost to sick leave;

   
    

• Days/hours lost to stress leave;

   
    

• Staff turnover rates (as a percentage of staff total);

   
    

• Staff burnout (as defined by the authors).

   

Kane 2007[55]

Nursing staffing models

7 case-control

3 case series

42 cross sectional

43 assessed temporality

Nurses in HIC

In hospital related mortality by increasing 1 RN FTE/patient day

 

Yes

0.92 (0.90-0.94)

    

Failure to rescue by increasing 1 RN FTE/patient day

  

0.91 (0.89; 0.94)

    

Length of stay by increasing 1 RN FTE/patient day

  

-0.25 (0.02)

Kane 2007[54]

Various authors had used different operational definitions for the RN-to-patient ratio, including number of patients cared for by 1 RN per shift and the number of RN FTEs per patient day, 1000 patient days, or occupied bed.

17 cohort,

7 cross sectional,

4 case control,

Nurses

Per additional full time equivalent per patient day

 

Yes

Per additional full time equivalent per patient day

    

Hospital related mortality in ICUs

  

0.91 (0.86-0.96

    

Surgical

  

0.84 (0.80-0.89)

    

Medical patients

  

0.94 (0.94-0.95)

    

An increase by 1 RN per patient day

  

An increase by 1 RN per patient day

    

Hospital acquired Pneumonia

  

0.70 (0.56-0.88)

    

Unplanned extubation

  

0.49 (0.36-0.67)

    

Respiratory failure

  

0.40 (0.27-0.59)

    

Cardiac arrest

  

0.72 (0.62-0.84)

    

Risk of failure to rescue

  

0.84 (0.79-0.90)

    

Length of stay was shorter by 24%

  

0.76 (0.62-0.94)

Thungjaroenkul 2007[56]

Nursing staff

17 studies: 2 prospective, 10 retrospective, 4 retrospective and prospective study, 1 Pre-post quasi-experimental design

Nurses in HIC

Patient length of stay

 

No

Sufficient numbers of RNs may prevent patient adverse events that cause patients to stay longer

    

Hospital costs

   

Zwarenstein 2009[52]

A practice-based intervention introduced to a practice setting with an explicit objective of improving collaboration between two or more health and/or social care professionals.

5 RCT

Health care professionals

Health measures

 

No

IPC interventions can improve healthcare processes and outcomes,

    

Quality of life measures

   
    

Complication rates