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Associations of safe nurse staffing coverage and care complexity factors with nursing-sensitive adverse events in cardiac inpatients: a cross-sectional multicenter study
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Background: Adverse events (AEs) are linked to nurse staffing levels and care complexity factors; however, evidence in patients hospitalized for cardiac conditions is limited. The acute to intensive care (ATIC) patient classification system measures patient acuity according to required nurse hours per patient day (NHPPD), thereby enabling calculation of nurse staffing coverage. A prior study defined safe nurse staffing coverage as achieving ≥90% of the required NHPPD with the available nurse staffing. The aim of this study was to examine the associations between safe nurse staffing coverage and care complexity factors and AEs in patients hospitalized for cardiac conditions in three high-complexity hospitals in Catalonia between January and December 2022.
Methods: This was a cross-sectional multicenter study that included patients admitted for cardiological reasons at three high-complexity hospitals of the Catalan Institute of Health in Catalonia between January and December 2022. Data regarding care complexity individual factors and patient acuity, according to the ATIC patient classification system, were obtained from electronic health records. The main outcomes were nursing-sensitive AEs that included falls, pressure ulcers, phlebitis, cardiorespiratory arrest, acute pulmonary edema (APE), and aspiration pneumonia. Safe nurse staffing coverage was defined as achieving ≥90% of the required NHPPD. Other clinical and sociodemographic variables were also collected. A descriptive and comparative analysis was performed.
Results: Among the 6,873 patients included in the study, 11.4% experienced one of the AEs studied, the most common being APE, present in 5% of cases. The mean nurse staffing coverage was 64.3%. Patients admitted to step-down units and those admitted for surgical reasons received the highest nurse staffing coverage, at 97.7% and 65.7%, respectively. The risk factors independently associated with AEs were old age, consciousness disorders, chronic disease, hemodynamic instability, and transmissible infection. Safe nurse staffing coverage was a protective factor against AEs.
Conclusions: Older age, consciousness disorders, chronic disease, hemodynamic instability, and transmissible infection were independently associated with nursing-sensitive AEs, while safe nurse staffing coverage was a protective factor. These findings should inform staffing decisions and shape future healthcare-management policies aimed at improving health outcomes among adults hospitalized in cardiology wards.
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ASENSIO FLORES, Susana, et al. Associations of safe nurse staffing coverage and care complexity factors with nursing-sensitive adverse events in cardiac inpatients: a cross-sectional multicenter study. Frontiers in Cardiovascular Medicine. 2026. Vol. 13. ISSN 2297-055X. [consulted: 3 of November of 2026]. Available at: https://hdl.handle.net/2445/232305