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22 Studies by the nation's most respected scientific and medical researchers affirm the significance of California's RN-to-patient ratios for patient safety n As a result of the ratios, California has far fewer patient deaths than comparable hospitals in Pennsylvania and New Jersey, RNs have more time for patients and miss fewer changes in patient conditions — Health Services Research, August 2010. n Understaffing of nurses is a key factor in the spread of methicillin-resistant staph infection (MRSA), the most dangerous type of hospital-acquired infection — Lancet Infectious Disease, July 2008. n Patients cared for in hospitals with higher RN staffing levels were 68 percent less likely to acquire a preventable infection, according to a review of outcome data of 15,000 patients in 51 U.S. hospitals — Medical Care, June 2007. n A 10 percent increase in adequate staffing and resources is associated with 17 fewer deaths per 1,000 discharged patients — Science Daily, Jan. 16, 2007. n Improved RN staffing ratios are associated with a reduction in hospital-related mortality, failure to rescue, and lengths of stay. Every additional patient assigned to an RN is associated with a 7 percent increase in the risk of hospital-acquired pneumonia, a 53 percent increase in respiratory failure, and a 17 percent increase in medical complications — Agency for Healthcare Research and Quality, May 2007. n If all hospitals increased RN staffing to match the top 25 percent best-staffed hospitals, more than 6,700 in-hospital patient deaths, and overall 60,000 adverse outcomes could be avoided — Health Affairs, January/February 2006. n Low nurse staffing levels are a key cause of 98,000 preventable deaths each year — Institute of Medicine, "Keeping Patients Safe: Transforming the Work Environment of Nurses," November 2003. n Up to 20,000 preventable patient deaths each year can be linked to low RN staffing. For each additional patient assigned to an RN, above four, the likelihood of death within 30 days increased by 7 percent — Journal of the American Medical Association, October 22, 2002. Most hospitals can afford to employ sufficient numbers of RNs to provide safe ratios n From 1993 through 2004, $157 billion was consumed by mergers and acquisitions in the hospital industry — an average of $402,000 per bed, the highest ever — Institute of Health and Socio-Economic Policy calculation of Irvi ng Levin Associates merger and acquisition data. n Nationally, hospitals expended $146.3 billion from 1993 to 2003 on information technology programs — Sheldon I. Dorenfest and Associates, 2004. Appendix Additional Studies and Data