When it comes to sepsis care, New York state is a national leader. Because of legislation known as Rory’s Regulations, hospitals are required to use a checklist of care and maintain certain staffing levels—though specific patient-to-nurse staffing ratios are not dictated.
These regulations and sepsis care bundles work to reduce sepsis-related deaths but could be improved upon. Specifically, implementing patient-to-nurse ratios in NY state holds promise for much greater reductions in sepsis deaths, suggests a study published in American Journal of Infection Control.
Currently, there is no requirement in New York that hospitals meet a minimum safe nurse staffing standard. Researchers from the Center for Health Outcomes and Policy Research (CHOPR) at the University of Pennsylvania School of Nursing looked at 116 hospitals in New York state and more than 52,000 hospitalized patients with a diagnosis of sepsis. On average in these hospitals, nurses cared for 6.3 patients each and staffing varied substantially by hospital from 4.3 patients-per-nurse in the best staffed hospitals to 10.5 patients per nurse in the worst staffed hospitals.
The study found that these ratios affected mortality from sepsis. Specifically, for each additional patient added to a nurse’s workload there was a:
- 12% higher in-hospital mortality from sepsis;
- 7% higher odds of 60-day mortality; and
- 7% higher odds of 60-day readmission, and longer lengths of stay
Compared with only a 5% improvement in mortality associated with improved adherence to mandated care bundles.
Additionally, the study showed that improved nurse staffing at the levels in the pending legislation, which is 4 patients per nurse, reduced length of stay two times more than the care bundles.
Patient-to-nurse staffing legislation
As of December 2020, The Safe Staffing for Quality Care Act (A2954/S51032) is pending action in the New York Legislature. It sets a minimum nurse staffing requirement for all New York state hospitals that would serve to bring hospitals with poor staffing to an evidence-based minimum standard. The wide variation in patient-to-nurse ratios in hospitals across the state is contributing to avoidable deaths for patients with sepsis. This bill hopes to bring all hospitals to the same standard as well as give protections to nurses who refuse to work when the standards are not met.
However, the fate of this bill passing seems to be slim considering that it has been in committee since January 2020.