Table 3.
Associations between turnover rates by clinical specialty and risk adjusted hospital outcomes at 30 days
| Mortality risk (95% CI) | Unplanned emergency readmission risk after elective surgery (95% CI) | |||
|---|---|---|---|---|
| All cause admissions | Emergency admissions | Elective admissions | ||
| Nurse turnover rate: | ||||
| Surgery | 0.013*** (0.006 to 0.019) | 0.018*** (0.009 to 0.027) | 0.004 (−0.003 to 0.011) | −0.010 (−0.039 to 0.020) |
| General medicine | 0.023*** (0.015 to 0.032) | 0.035*** (0.022 to 0.048) | 0.005 (−0.002 to 0.012) | −0.015 (−0.054 to 0.024) |
| Acute internal medicine | 0.008 (−0.002 to 0.018) | 0.014* (−0.001 to 0.029) | −0.005 (−0.013 to 0.003) | 0.031* (−0.000 to 0.062) |
| Senior doctor turnover rate: | ||||
| Surgery | 0.005 (−0.002 to 0.012) | 0.008 (−0.002 to 0.018) | −0.003 (−0.010 to 0.003) | 0.028* (−0.001 to 0.057) |
| General medicine | 0.007 (−0.003 to 0.018) | 0.009 (−0.006 to 0.024) | −0.002 (−0.010 to 0.007) | 0.011 (−0.020 to 0.042) |
| Acute internal medicine | 0.003 (−0.007 to 0.013) | 0.006 (−0.009 to 0.020) | −0.003 (−0.011 to 0.005) | 0.012 (−0.021 to 0.044) |
| Control covariates: | ||||
| No of nurses, surgery | 0.131** (0.001 to 0.262) | 0.154 (−0.037 to 0.346) | −0.016 (−0.096 to 0.063) | −0.155 (−0.450 to 0.140) |
| No of nurses, general medicine | 0.007 (−0.095 to 0.109) | −0.041 (−0.189 to 0.107) | 0.021 (−0.057 to 0.098) | 0.098 (−0.204 to 0.401) |
| No of nurses, acute internal medicine | 0.045* (−0.004 to 0.094) | 0.051 (−0.018 to 0.120) | 0.001 (−0.032 to 0.034) | 0.031 (−0.084 to 0.147) |
| No of senior doctors, surgery | −0.069 (−0.170 to 0.032) | −0.067 (−0.220 to 0.086) | 0.006 (−0.058 to 0.071) | −0.076 (−0.360 to 0.208) |
| No of senior doctors, general medicine | −0.013 (−0.089 to 0.062) | −0.001 (−0.105 to 0.103) | 0.012 (−0.036 to 0.060) | 0.020 (−0.256 to 0.296) |
| No of senior doctors, acute internal medicine | 0.020 (−0.005 to 0.045) | 0.027 (−0.008 to 0.062) | −0.014* (−0.029 to 0.002) | 0.005 (−0.073 to 0.084) |
| Quarter 2: Apr-June | −0.463*** (−0.482 to −0.443) | −0.631*** (−0.659 to −0.604) | −0.046*** (−0.071 to −0.021) | 0.206*** (0.149 to 0.263) |
| Quarter 3: July-Sept | −0.598*** (−0.621 to −0.575) | −0.810*** (−0.842 to −0.778) | −0.046*** (−0.062 to −0.030) | 0.246*** (0.181 to 0.311) |
| Quarter 4: Oct-Dec | −0.201*** (−0.218 to −0.185) | −0.293*** (−0.317 to −0.268) | −0.030*** (−0.045 to −0.016) | 0.112*** (0.058 to 0.165) |
| Constant | 3.005*** (2.992 to 3.019) | 4.519*** (4.500 to 4.537) | 0.496*** (0.484 to 0.508) | 6.202*** (6.165 to 6.240) |
| R2 | 0.332 | 0.298 | 0.005 | 0.008 |
CI=confidence interval.
Baseline models estimated using ordinary least squares with (NHS hospital trust×financial year) fixed effects with 95% CIs. Variables of interest and number of staff (nurses and senior doctors) are also standardised for ease of interpretation. NHS hospital trusts×months (N×T)=14 524. Heteroskedasticity and autocorrelation consistent standard errors are clustered at NHS hospital trust level.
Significance level: *P<0.1; **P<0.05; ***P<0.01.