By Stephen Beech via SWNS
Patients are more likely to die in NHS hospitals with a high turnover of doctors and nurses, according to a new study.
High monthly turnover rates of medical staff are associated with higher deaths for emergency patients admitted to NHS hospitals in England, according to the findings published by The BMJ.
Researchers say that efforts to reduce changes among healthcare workers may improve patient care and hospital quality.
The retention of doctors and nurses is “critical” for the provision of patient care, as acknowledged by the NHS’s long-term workforce plan.
Previous studies have investigated the association between clinical staff turnover and increased organizational costs but, so far, researchers have not been able to measure both staff turnover and its effect on patient health at a national level.
For the new study, researchers set out to investigate the association between monthly turnover rates of nurses and senior doctors with deaths and unplanned readmissions for patients admitted to hospitals over nine years.
The findings were based on yearly records for 236,000 nurses; 41,800 senior doctors and 8.1 million patients admitted to 148 NHS acute hospital trusts in England from April 2010 to March 2019.
The main outcomes of interest were the risk of death from any cause within 30 days of hospital admission, and the risk of unplanned readmission within 30 days of discharge after elective hospital treatment.
After accounting for patient age, sex, and pre-existing conditions, the research team found that an increase in the monthly turnover rate for nurses – equivalent to about 20 nurses quitting the hospital trust – was associated with 35 additional deaths per 100,000 admissions in a given month, equivalent to an extra 239 deaths per month across the 148 hospital trusts.
For senior doctors, an increase in the monthly turnover rate – equivalent to about seven senior doctors quitting the hospital trust – was associated with 14 additional deaths per 100,000 admissions in a given month, equivalent to an extra 96 deaths per month across the 148 hospital trusts.
Study author Dr. Giuseppe Moscelli said: “Higher nurse turnover was linked to increased deaths for patients on surgical and general medicine wards, while higher turnover among senior doctors was linked to increased deaths in patients with infectious diseases and mental health disorders.
“No statistically significant association was seen between staff turnover rates and deaths for non-emergency care patients, likely due to the higher risk of death in patients requiring emergency admission.”
The research team acknowledged that the findings were observational, so no firm conclusions can be drawn.
However, they pointed out that it was a large study that analyzed nearly a decade of data across all acute NHS hospital trusts in England, and results were similar after further analyses to test the strength of the associations.
Dr. Moscelli, an Associate Professor in the School of Social Sciences at the University of Surrey, said that while further research is needed to investigate the mechanisms behind the associations, a “pragmatic” approach to reducing hospital staff turnover rates would be to focus on factors such as pay packages, staff engagement, and more favorable working conditions.
He added: “The government could also prioritize NHS sector pay rises for nurses because lower nurse turnover rates may actually carry higher returns to patient care and increasing retention of senior doctors.”
Professor Hogne Sandvik said the findings highlight the importance of continuity of care.
In an editorial accompanying the research, he says continuity is a “major challenge” for managers and policymakers, and staff retention depends on several factors including a streamlined onboarding process, investment in personal and professional development and training, and a supportive leadership environment.
Sandvik, of the Norwegian Research Centre, added: “High turnover of nurses and doctors suggests a potential risk for patients.
“Therefore, retention of healthcare staff should be a priority to improve continuity and quality of care for patients.”
