Association of nurse–patient ratios with outcomes in patients on peritoneal dialysis

Abstract

Centre-related factors, in addition to patient-related factors, are known to influence the outcomes of patients on peritoneal dialysis (PD). It is unclear if the nursing staff-to-patient ratios at different PD centres affect peritonitis outcomes. Our study aimed to examine whether full-time equivalent (FTE) PD nurse–patient ratios in individual PD centres were associated with centre-level outcomes of patients on PD. We used a cross-sectional survey of nursing leads of PD units across Australia and multi-centre registry data linkage. Of the 38 PD units in Australia, 28 (73.7%) nursing leads responded to the survey. The overall FTE PD nurse–patient ratio was 1 nurse to 12.7 patients (median; interquartile range 9.8–16.5), with substantial variability between PD units. There was no significant association between the FTE PD nurse–patient ratios and unit-specific peritonitis rates, overnight hospitalisation rates for peritonitis, mortality rates within 30 days of infection, or haemodialysis (HD) transfer rates. However, there was a moderate positive correlation between nurse FTE and transfer to HD rates (r = 0.476, p < 0.01). While our study revealed large variability in FTE PD nurse–patient ratios between PD units across the country, it was not associated with clinically significant PD outcomes between centres. Therefore, PD nurse–patient ratios may not be an important centre-related factor to explain variability in clinically meaningful PD outcomes between centres.