BMJ Editorial: Staff retention and mortality (20 November 2024)

Summary

Previous research suggests that survival of patients may be associated with hospital organisational culture. Organisational factors such as culture, staffing, and retention of staff are crucial to patient safety. In a linked study covering nine years of monthly data from all NHS acute trusts in England, Moscelli and colleagues showed that a high turnover of senior doctors (hospital consultants and specialty associated doctors) and nurses in hospitals is associated with increased mortality for patients admitted for emergencies. For the 30 day mortality risk, a 1 standard deviation increase in the monthly turnover rate of nurses was associated with a 0.052 percentage point increase and of senior doctors was a 0.019 percentage point increase.

Turnover rates among nurses showed a stronger association with mortality than turnover rates among doctors. One potential explanation is that while doctors usually meet patients one to one, nurses more often work in teams, which may be disrupted by high turnover rates.

No significant association was reported between staff turnover and mortality for elective patients. As the authors suggest, this difference may be explained by the fact that elective patients have a lower mortality risk than patients in emergency departments. It should also be noted that well practiced processes are especially important in emergency settings where time is crucial. Decisions must be taken quickly and under stress. Therefore, patients in the emergency departments might be particularly susceptible to when the staff is less experienced or not well settled into their team.