Cho Sung-Hyun, Hwang Jeong Hae, Kim Jaiyong
Department of Nursing, Hanyang University, Korea.
Nurs Res. 2008 Sep-Oct;57(5):322-30. doi: 10.1097/01.NNR.0000313498.17777.71.
Research evidence suggests that nurse staffing influences patient outcomes.
To examine the relationship between nurse staffing and patient mortality in Korean intensive care units (ICUs).
Using survey and administrative databases, this study included 27,372 ICU patients discharged from 42 tertiary and 194 secondary hospitals. Ownership (public vs. private), location (metropolitan city vs. province), size, specialization of ICUs (specialized vs. mixed), physician staffing and nurse staffing, and years of nurse experience were included as hospital and ICU characteristics. Nurse staffing was measured as the ratio of average daily census to the total number of full-time equivalent registered nurses in ICUs. Age, gender, 26 categories of primary diagnoses, 16 groups of comorbid conditions, and source of payment were used for risk adjustment. Mortality was defined as deaths that occurred in the hospital or on the date of hospital discharge. Using SAS GLIMMIX procedures, multivariate logistic regression analysis was employed separately for tertiary and secondary hospitals.
In tertiary hospitals, a greater likelihood of dying was found among patients who were admitted to a mixed ICU (odds ratio [OR] = 1.61, 95% confidence interval [CI] = 1.14-2.26) and where there was no board-certified physician present for 4 or more hours per day (OR = 1.56, 95% CI = 1.20-2.01). In secondary hospitals, every additional patient per RN was associated with a 9% increase in the odds of dying (OR = 1.09, 95% CI = 1.04-1.14). Nurse experience had no significant relationship with mortality.
Nurse and physician staffing and specialization of ICUs impacted patient mortality. Associations differed in tertiary and secondary hospitals. Further investigation of the impact of organizational environments in ICUs is needed.
研究证据表明护士配备情况会影响患者预后。
探讨韩国重症监护病房（ICU）护士配备与患者死亡率之间的关系。
本研究利用调查和管理数据库，纳入了从42家三级医院和194家二级医院出院的27372例ICU患者。医院和ICU的特征包括所有制类型（公立与私立）、地点（大城市与省份）、规模、ICU的专科类型（专科与综合）、医生配备和护士配备，以及护士的工作年限。护士配备以ICU平均每日普查人数与全职等效注册护士总数的比例来衡量。年龄、性别、26种主要诊断类别、16组合并症组以及支付来源用于风险调整。死亡率定义为在医院内或出院当日发生的死亡。使用SAS GLIMMIX程序，分别对三级医院和二级医院进行多变量逻辑回归分析。
在三级医院中，入住综合ICU的患者死亡可能性更大（优势比[OR]=1.61，95%置信区间[CI]=1.14 - 2.26），且每天有4小时或更长时间没有获得董事会认证的医生在场的患者死亡可能性更大（OR = 1.56，95% CI = 1.20 - 2.01）。在二级医院中，每增加一名患者对应一名注册护士，死亡几率增加9%（OR = 1.09，95% CI = 1.04 - 1.14）。护士工作经验与死亡率无显著关系。
护士和医生的配备以及ICU的专科类型影响患者死亡率。三级医院和二级医院中的关联有所不同。需要进一步调查ICU组织环境的影响。
