Authors (including presenting author) :
WONG WY(1), NGAI SCJ(1), HUNG YKS(1), LI WC(1)
Affiliation :
(1) CENTRAL NURSING DIVISION, QUEEN ELIZABETH HOSPITAL
Introduction :
Many international studies have previously linked high bed occupancy with worse patient outcomes, including mortality. High levels of bed occupancy could indicate bed shortages and poor patient flow, patient could not receive care as expected and in turn may lead to worse outcomes and potentially more patients dying. However, some studies argued that the nurse workload instead of crude number of patients are actually related.
Objectives :
To explore the bed occupancy and nurses’ turnover on the mortality rate in a local acute hopital
Methodology :
This study retrospectively collected data about the occupancy rate and mortality rate among all by departments in an acute hospital from Jan 2019 to Mar 2020. Besides the nursing manpower by headcounts in Medical & Neurosurgical Department has been retrieved from Jan 2019 to Mar 2020. Pearson correlation test and Spearman correlation test has been done to explore the relationship between occupancy rate and mortality rate as well as the nursing manpower by headcount and mortality rate.
Result & Outcome :
The bed occupancy rate from Jan 2019 to Mar 2020 among overall departments ranged from 75.1% to 102.4%. The in-patient bed occupancy rate is specifically high in the following departments, Medical (115.1%), Neurosurgery (99.3%), Orthopaedics (115.2%) and Surgery (105.2%).
Overall mortality rate per 1000 patients treated from Jan 2019 to Mar 2020 ranged from 14.0 to 30.4, with average 18.7. the mortality rate in each department are as follow, medical (29.0), Neurosurgery (49.8), Orthopaedics (13.9) and Surgery (13.8).
In neurosurgery, the significant positive relationship between ward OR% and Mortality alert the clinical team to pay attention or develop clinical alert system to strengthen clinical care and ensure patients safety in order to free from hospital acquired complications such as sepsis or fall.
In medicine, the negative relationship between the ward OR% and Mortality rate indicated the case severity is less than expected. Therefore, more vigorous case selection for step down and discharge once clinical condition become stable or explore more care pathway on specific disease group to guide the clinical decision thro assistance of big data may help to ease the ward congestion.
There is a significant positive relationship between occupancy rate and mortality rate in overall all departments included. However, the result was not consistent in each of the individual department. Those 4 departments mentioned did not show any positive relationship with the mortality rate individually. Therefore, we proposed that further study on the Nurse workload instead of just occupancy as that many other factors may contribute to the mortality rate.
The second part of the study, the nursing headcount and mortality rate in Medical and Neurosurgical Department has been studied from Jan 2020 to Mar 2020. The correlation test results demonstrated that there is a significant negative relationship between headcount and mortality rate in overall, which means that low manpower may be related to high mortality risk. But the result was not consistent in individual Medical & Neurosurgical Department. Therefore, it was suggested to explore further on the nurse-to-patient ratio and staffing level on mortality rate.
