重症监护病房护士人员配备与腹主动脉手术后并发症风险

Intensive care unit nurse staffing and the risk for complications after abdominal aortic surgery.

作者信息

Pronovost P J, Dang D, Dorman T, Lipsett P A, Garrett E, Jenckes M, Bass E B

机构信息

Johns Hopkins University Schools of Medicine, and Hygiene and Public Health, Baltimore, Md., USA.

出版信息

Eff Clin Pract. 2001 Sep-Oct;4(5):199-206.

PMID:11685977

Abstract

CONTEXT

We previously found that length of stay in the intensive care unit (ICU) after abdominal aortic surgery increased when fewer ICU nurses were available per patient. We hypothesized that having fewer nurses increases the risk for medical complications.

OBJECTIVE

To evaluate the association between nurse-to-patient ratio in the ICU and risk for medical and surgical complications after abdominal aortic surgery.

DESIGN

Observational study.

SETTING

All nonfederal acute care hospitals in Maryland.

DATA SOURCES

Information about patients came from hospital discharge data on all patients in Maryland with a principal procedure code for abdominal aortic surgery from 1994 through 1996 (n = 2606). The organizational characteristics of ICUs were obtained by surveying ICU medical and nursing directors in 1996 at the 46 Maryland hospitals that performed abdominal aortic surgery. Thirty-nine of the ICU directors (85%) completed the survey.

EXPOSURE

Surgery in hospitals with fewer ICU nurses (in which each nurse cared for three or four patients) compared with hospitals with more ICU nurses (in which each nurse cared for one or two patients).

OUTCOME

Proportion of patients who developed postoperative complications.

RESULTS

Seven hospitals with 478 patients had fewer ICU nurses, and 31 hospitals with 2128 patients had more ICU nurses. Patients in hospitals with fewer nurses were more likely than patients in hospitals with more nurses to have complications: 47% vs. 34% had any complication, 43% vs. 28% had any medical complication, 24% vs. 9% had pulmonary insufficiency after a procedure, and 21% vs. 13% were reintubated (P < 0.001 for all comparisons). After adjustment for patient, hospital, and surgeon characteristics, having fewer versus more ICU nurses was associated with an increased risk for any complication (relative risk, 1.7 [95% CI, 1.3 to 2.4]), any medical complication (relative risk, 2.1 [CI, 1.5 to 2.9]), pulmonary insufficiency after procedure (relative risk, 4.5 [CI, 2.9 to 6.9]) and reintubation (relative risk, 1.6 [CI, 1.1 to 2.5]).

CONCLUSION

Having fewer ICU nurses per patient is associated with increased risk for respiratory-related complications after abdominal aortic surgery.

摘要

背景

我们之前发现，腹主动脉手术后在重症监护病房（ICU）的住院时间会因每位患者可获得的ICU护士数量减少而延长。我们推测护士数量减少会增加医疗并发症的风险。

目的

评估ICU护患比与腹主动脉手术后医疗和手术并发症风险之间的关联。

设计

观察性研究。

地点

马里兰州所有非联邦急症护理医院。

数据来源

患者信息来自1994年至1996年马里兰州所有主要手术编码为腹主动脉手术的患者的医院出院数据（n = 2606）。ICU的组织特征是通过1996年对马里兰州46家进行腹主动脉手术的医院的ICU医疗和护理主任进行调查获得的。39位ICU主任（85%）完成了调查。

暴露因素

与护士较多的医院（每位护士护理一或两位患者）相比，护士较少的医院（每位护士护理三或四位患者）中的手术。

结局

发生术后并发症的患者比例。

结果

7家医院的478名患者ICU护士较少，31家医院的2128名患者ICU护士较多。护士较少的医院中的患者比护士较多的医院中的患者更易出现并发症：任何并发症的发生率分别为47%和34%，任何医疗并发症的发生率分别为43%和28%，术后肺功能不全的发生率分别为24%和9%，再次插管的发生率分别为21%和13%（所有比较P < 0.001）。在对患者、医院和外科医生特征进行调整后，ICU护士较少与较多相比，任何并发症的风险增加（相对风险，1.7 [95% CI，1.3至2.4]），任何医疗并发症的风险增加（相对风险，2.1 [CI，1.5至2.9]），术后肺功能不全的风险增加（相对风险，4.5 [CI，2.9至6.9]）以及再次插管的风险增加（相对风险，1.6 [CI，1.1至2.5]）。