Work unit level personnel working hours and the patients’ length of in-hospital stay–An administrative data approach

Administrative data accumulating daily from hospitals would provide new possibilities to assess work shifts and patient care. We aimed to investigate associations of work unit level average work shift length and length of patient in-hospital stay, and to examine the role of nurse-patient-ratio, year, night work, age, work units and working hours at the work units for these estimations. The data for this study were based on combined administrative day-to-day patient and pay-roll based objective working hour data of employees of one hospital district in Finland for 2013–2019. Three patient measures were calculated: the overall length of in-hospital stay, the length of in-hospital stay before a medical procedure and the length of in-hospital stay after a medical procedure. A Generalized Linear Mixed Model (GLMM) with multivariate normal random effects was used with Penalized Quasi-Likelihood for relative risk ratios (RR) with 95% confidence intervals (CI). The results showed that compared to 10 hours work shifts were associated with a decreased likelihood of the overall length of in-hospital stay (RR 0.94, 95% CI 0.94, 0.95) and length of in-hospital stay after a medical procedure among all occupations (RR 0.94, 95% CI 0.92, 0.97). These associations retained the magnitude and direction in the models additionally adjusted for work, employee, and patient characteristics, and the associations were weaker for nurses than among all occupations. To conclude, compared with the standard work shifts, 8–10 hours work shifts seem to be associated with longer, and >10 hours work shifts with shorter length of in-hospital stay. Administrative data provides feasible possibilities to investigate working hours and length of in-hospital stay.Author summary: To growing extent, health care sector collects routinely administrative data for day-to-day patient and employee related activities, e.g., hospital admissions, length of in-hospital stay, or employee working hours. These data provide possibilities not only for research, but also for decision-making to increase understanding and improve personnel management, workflow, and usability of health care systems. Our access to combined administrative day-to-day patient and pay-roll based objective working hour data of employees of one hospital district in Finland for 2013–2019 enabled us to investigate the associations between employee’s work shift length at work unit level and patients’ length of in-hospital stay. We observed that 8–10 hours work shift length was associated with longer length of in-hospital stay of patients, whereas work shift length exceeding 10 hours was linked with shorter in-hospital stay. We found weaker associations for registered nurses and practical nurses compared to all occupations. These findings indicate that administrative data provides possibilities to investigate working hours and in-hospital stay length and potentially such data can be utilized even in hospital level.