Multilevel model for missed care
| Number of items of missed care observed during a shift | Shifts where at least one item of missed care was observed | |||||||
|---|---|---|---|---|---|---|---|---|
| Β | L95% | U95% | p Value | OR | L95% | U95% | p Value | |
| Ward level variables | ||||||||
| Directorate (χ2, p value)* | (6.702, 0.035) | (1.846,.40) | ||||||
| Surgical | −1.028 | −1.902 | −0.154 | 0.021 | 0.981 | 0.438 | 2.200 | 0.963 |
| Medical | −0.817 | −1.695 | 0.061 | 0.068 | 1.179 | 0.520 | 2.676 | 0.693 |
| Medical/surgical | 0.000 | 1.000 | ||||||
| Practice Environment Scale (PES-28) | −2.726 | −3.312 | −2.140 | <0.001 | 0.356 | 0.195 | 0.648 | <0.001 |
| Nurse level variables | ||||||||
| Shift (χ2, p value)* | (32.545, <0.001) | (44.054, <0.001) | ||||||
| Day | 0.866 | 0.564 | 1.168 | <0.001 | 2.751 | 2.018 | 3.750 | <0.001 |
| Afternoon/evening | 0.721 | 0.345 | 1.097 | <0.001 | 2.588 | 1.698 | 3.945 | <0.001 |
| Night | 0.000 | 1.000 | ||||||
| Assistance with daily living (no. patients) | 0.049 | 0.025 | 0.073 | <0.001 | 1.041 | 1.009 | 1.074 | 0.012 |
| Frequent monitoring(no. patients) | 0.073 | 0.040 | 0.106 | <0.001 | 1.057 | 1.006 | 1.110 | 0.028 |
| Nurse staffing variables | ||||||||
| Patients per RN (χ2, p value)† | (36.296, <0.001) | (37.537, <0.001) | ||||||
| up to 6.13 | −1.087 | −1.501 | −0.673 | <0.001 | 0.343 | 0.220 | 0.534 | <0.001 |
| 6.14–7.33 | −0.427 | −0.839 | −0.015 | 0.042 | 0.574 | 0.361 | 0.912 | 0.019 |
| 7.40–9.25 | −0.201 | −0.595 | 0.193 | 0.317 | 0.847 | 0.538 | 1.335 | 0.474 |
| 9.33–11.50 | −0.121 | −0.488 | 0.246 | 0.518 | 0.971 | 0.623 | 1.516 | 0.898 |
| 11.67 and over | 0.000 | 1.000 | ||||||
| Patients per HCSW (χ2, p value)† | (3.451, 0.48) | (3.021,.55) | ||||||
| up to 6.80 | 0.288 | −0.098 | 0.674 | 0.144 | 1.154 | 0.773 | 1.721 | 0.483 |
| 7.00–9.25 | 0.284 | −0.106 | 0.674 | 0.154 | 0.872 | 0.581 | 1.308 | 0.508 |
| 9.33–13.00 | 0.305 | −0.058 | 0.668 | 0.099 | 1.033 | 0.709 | 1.504 | 0.867 |
| 13.33–17.00 | 0.261 | −0.102 | 0.624 | 0.158 | 1.201 | 0.818 | 1.763 | 0.350 |
| 17.33 and over | 0.000 | 1.000 | ||||||
| Random variance | σ2 | L95% | U95% | σ2 | L95% | U95% | ||
| Hospitals (n=46) | 0.128 | 0.000 | 0.265 | 0.067 | 0.154 | 0.013 | 0.295 | 0.032 |
| Wards (n=392) | 0.482 | 0.231 | 0.733 | <0.001 | 0.062 | −0.134 | 0.258 | 0.535 |
| Nurses (n=2566) | 7.541 | 7.096 | 7.986 | n/a‡ | ||||
*Two degrees of freedom.
†Four degrees of freedom.
‡In multilevel logistic regression model the residual variance at the nurse level is a function of the estimated model parameters and will therefore vary for each individual nurse unless the data (independent variables) for one or more nurses are the same.
HCSW, healthcare support worker; RN, registered nurses.