gms | German Medical Science

Background and Purpose: In 2016, psychiatry representatives of the German “Gemeinsamer Bundesausschuss” claimed that there was hardly any international evidence that could show a significant association between staffing levels in mental hospitals and patient-related outcomes. This systematic review presents the evidence published for psychiatry up to date.

Methods: Systematic Review.

Research Focus: In autumn 2016, a complex search string containing both terms relevant for staffing in psychiatry and terms relevant for patient-related outcomes was developed. This search string was adapted to the Pubmed and EBSCO CINAHL search logics, resulting in more than 7.100 records after duplicates removed. More than 400 full-text articles were assessed for eligibility.

Methodological and Theoretical Focus: The political process of re-defining calculations of budgets for psychiatric hospitals has been initiated by the new Reimbursement Law PsychVVG but is still under discussion and further development. Therefore it will be important to show evidence for the impact of staffing level on patient-related outcomes.

Results: The finally included 63 articles are dominated by Anglo-Saxian and East-Asian studies. There is some inconsistent evidence for both significantly positive and negative associations between nurse (student) staffing levels and patient safety resp. recovery.

Conclusions: Especially in Europe, better research with more rigid, context-sensitive research designs is urgently needed to show clearer evidence that downsizing the nurse-to-patient-ratio on psychiatric units will soon result in negative effects for in-patients. But there are both financial and ethical limits for such an endeavour.