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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


Description of included interventions

Type of studies included (no)

Targeted health care providers

Outcome reported

Pooled data (Y/N)



Other outcomes

MNCH specific outcomes


Butler 2011[53]

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

RCT: 08


CCT: 02

Hospital nursing staff and hospital patients in HIC

In-hospital mortality



0.96 (0.59-1.56)


Length of stay


1.35 lower (1.92-0.78)




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;



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



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,


Per additional full time equivalent per patient day



Per additional full time equivalent per patient day


Hospital related mortality in ICUs


0.91 (0.86-0.96




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



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.


Health care professionals

Health measures



IPC interventions can improve healthcare processes and outcomes,


Quality of life measures


Complication rates