When medical malpractice attorneys evaluate cases, they frequently look for a particular error by a medical professional which leads the patient to suffer an adverse consequence and can be pinpointed as outside the standard of care by an expert in the field. A new study published in BMJ Open has identified insufficient staffing levels as a possible cause of mortality, and this raises the question of whether institutional factors should be taken into account when compensating patients in addition to a particular medical error.

According to the study, hospitals with a higher nurse-to-patient ratio have lower patient mortality. Hospitals where nurses care for less than six patients are able to reduce the patient mortality rate compared to their competition.

The study covered two years and 137 acute care trusts in 46 hospitals in the United Kingdom. In general, fewer patients per nurse led to a lower risk of mortality of both surgical and medical inpatients. If a hospital staffed a shortage with medical assistants or nurses rather than registered nurses, they actually fared worse in patient mortality than places with more registered nurses.

This is likely one of many factors that goes into the overall qualify of care at a hospital. Other studies have looked at the problem of exhaustion and burnout in the medical profession. Indeed, a University of Pennsylvania study last year found a lower mortality rate when nurses were happier with their jobs.

Insufficient staffing has been an allegation in cases brought under the False Claims Act as skilled nursing facilities charge the government a daily rate for patient care. If they are not providing the level of services expected by the government and patients are injured as a result, the United States may seek to reclaim the funds paid for patient care from the facility.

It is unlikely that medical malpractice lawsuits will move to a standard like this one in determining whether a hospital should be liable for patient harm. However, several years ago, California’s Assembly Bill 394 required the Department of Health Services to establish minimum licensed nurse to patient ratios. If other states were to pass similar laws, perhaps patients suffering injury due to insufficient staffing would have a better argument for a medical error caused by insufficient staffing.