Tuesday, November 6, 2007

This presentation is part of : Outcomes Measurement Initiatives
The Effect of Patient Turnover on the Occurrence of Patient Incidents
Mary F. Kanak, RN, APRN, BC, Mercy Medical Center, Cedar Rapids, IA, USA
Learning Objective #1: verbalize the significant impact of patient turnover on the occurrence of documented patient incidents in a selected heart failure population.
Learning Objective #2: verbalize the importance of effectiveness research in advancing the science and knowledge of patient outcomes.

Patient turnover was identified as a factor that contributes to nursing workload and poses a risk to patient safety (IOM 2004).  This study explored associations between patient turnover and the occurrence of patient incidents in an acute care setting.  The conceptual model was a modification of Cho’s Nurse Staffing and Patient Outcomes Model (Cho, 2001). The sample of 261 heart failure hospitalizations was obtained from a data repository constructed for a larger funded study of nursing outcomes effectiveness research. The independent variable of patient turnover was defined as the sum of patient admissions, discharges and transfers for a specified nursing unit and time period, divided by the number of patient hours for that unit and time period.  The average patient turnover was calculated for the hour during which the incident occurred, and the four and eight-hour periods immediately preceding the incident.  The dependent variable of patient incident was defined as the reported occurrence of a medication error, patient fall, procedure-related or equipment-related incident.  A retrospective case-control design was used.  A sample of 103 cases (hospitalizations including an incident) and 158 controls (hospitalizations without incident) was matched on numerous demographic and clinical variables.  Logistic regressions were used to analyze the data for associations between patient turnover and the occurrence of incidents. It was found that patient turnover in the four hours preceding the incident was negatively associated with the recorded occurrence of an incident (p = .02).  As the patient turnover ratio increased, the odds of a reported incident decreased. Perhaps as nursing workload increased with greater patient turnover, less time was available for staff to detect incidents or record them for entry in the hospital incident reporting system.  This study supports the contention that increased patient turnover contributes to nursing workload but not to the reporting of incidents.