Schubert Maria, Clarke Sean P, Glass Tracy R, Schaffert-Witvliet Bianca, De Geest Sabina
Institute of Nursing Science, University of Basel, Basel, Switzerland.
Int J Nurs Stud. 2009 Jul;46(7):884-93. doi: 10.1016/j.ijnurstu.2008.10.008. Epub 2008 Dec 25.
In the Rationing of Nursing Care in Switzerland Study, implicit rationing of care was the only factor consistently significantly associated with all six studied patient outcomes. These results highlight the importance of rationing as a new system factor regarding patient safety and quality of care. Since at least some rationing of care appears inevitable, it is important to identify the thresholds of its influences in order to minimize its negative effects on patient outcomes.
To describe the levels of implicit rationing of nursing care in a sample of Swiss acute care hospitals and to identify clinically meaningful thresholds of rationing.
Descriptive cross-sectional multi-center study.
Five Swiss-German and three Swiss-French acute care hospitals.
1338 nurses and 779 patients.
Implicit rationing of nursing care was measured using the newly developed Basel Extent of Rationing of Nursing Care (BERNCA) instrument. Other variables were measured using survey items from the International Hospital Outcomes Study battery. Data were summarized using appropriate descriptive measures, and logistic regression models were used to define a clinically meaningful rationing threshold level.
For the studied patient outcomes, identified rationing threshold levels varied from 0.5 (i.e., between 0 ('never') and 1 ('rarely') to 2 ('sometimes')). Three of the identified patient outcomes (nosocomial infections, pressure ulcers, and patient satisfaction) were particularly sensitive to rationing, showing negative consequences anywhere it was consistently reported (i.e., average BERNCA scores of 0.5 or above). In other cases, increases in negative outcomes were first observed from the level of 1 (average ratings of rarely).
Rationing scores generated using the BERNCA instrument provide a clinically meaningful method for tracking the correlates of low resources or difficulties in resource allocation on patient outcomes. Thresholds identified here provide parameters for administrators to respond to whenever rationing reports exceed the determined level of '0.5' or '1'. Since even very low levels of rationing had negative consequences on three of the six studied outcomes, it is advisable to treat consistent evidence of any rationing as a significant threat to patient safety and quality of care.
在瑞士护理资源分配研究中，隐性护理资源分配是唯一始终与所有六项研究的患者结局显著相关的因素。这些结果凸显了资源分配作为一个关乎患者安全和护理质量的新系统因素的重要性。由于至少部分护理资源分配似乎不可避免，因此确定其影响阈值以尽量减少其对患者结局的负面影响很重要。
描述瑞士急症护理医院样本中隐性护理资源分配的水平，并确定具有临床意义的资源分配阈值。
描述性横断面多中心研究。
五家瑞士德语区和三家瑞士法语区的急症护理医院。
1338名护士和779名患者。
使用新开发的巴塞尔护理资源分配程度（BERNCA）工具测量隐性护理资源分配。其他变量使用国际医院结局研究系列中的调查项目进行测量。数据使用适当的描述性指标进行汇总，并使用逻辑回归模型定义具有临床意义的资源分配阈值水平。
对于所研究的患者结局，确定的资源分配阈值水平从0.5（即介于0（“从不”）和1（“很少”）到2（“有时”））不等。确定的三项患者结局（医院感染、压疮和患者满意度）对资源分配特别敏感，在任何持续报告存在资源分配的情况下（即平均BERNCA评分为0.5或更高）都显示出负面后果。在其他情况下，负面结局的增加首先在评分为1（平均评分为“很少”）的水平上被观察到。
使用BERNCA工具生成的资源分配分数为追踪资源不足或资源分配困难与患者结局之间的相关性提供了一种具有临床意义的方法。此处确定的阈值为管理人员在资源分配报告超过确定的“0.5”或“1”水平时做出反应提供了参数。由于即使是非常低水平的资源分配也对六项研究结局中的三项产生了负面影响，因此建议将任何资源分配的持续证据视为对患者安全和护理质量的重大威胁。
