高医院入住率、护士人员配备水平差异、周末入院和季节性流感所带来的住院死亡率风险比较。

A comparison of in-hospital mortality risk conferred by high hospital occupancy, differences in nurse staffing levels, weekend admission, and seasonal influenza.

机构信息

Robert Wood Johnson Clinical Scholars Program, University of Michigan, Ann Arbor, MI 48109, USA.

出版信息

Med Care. 2010 Mar;48(3):224-32. doi: 10.1097/MLR.0b013e3181c162c0.

DOI:10.1097/MLR.0b013e3181c162c0

PMID:20168260

Abstract

BACKGROUND

Hospital occupancy, nurse staffing levels, weekend admission, and seasonal influenza have all been shown to be associated with in-hospital mortality. Yet, no study has simultaneously compared the strength of associations of these 4 factors with in-hospital mortality.

OBJECTIVE

To compare the risk of in-hospital mortality conferred by high hospital occupancy on admission, increased nurse staffing levels, weekend admission, and seasonal influenza.

STUDY DESIGN

Retrospective cohort study of 166,920 patients admitted to 39 Michigan hospitals between 2003 and 2006. Participants were adults, age > or = 65 years, admitted through the emergency department with 6 common discharge diagnoses (acute myocardial infarction, congestive heart failure, stroke, pneumonia, hip fracture, gastrointestinal bleeding). We used logistic regression to compare the differences in the predicted probability of death conferred by each of the 4 factors, controlling for patient age, gender, discharge diagnosis, and comorbid conditions.

RESULTS

Each of the 4 factors had a statistically significant, independent association with in-hospital mortality. Seasonal influenza conferred the greatest increase in absolute risk of in-hospital mortality (0.5 percentage points; 95% CI, 0.23-0.76), followed by weekend admission (0.32, 0.11-0.54), and high hospital occupancy on admission (0.24, 0.06-0.43). Increased nurse staffing levels decreased the absolute risk of mortality by 0.25 percentage points (0.04-0.48) for each additional full-time equivalent nurse per patient-day.

CONCLUSION

Hospital occupancy, nurse staffing levels, weekend admission, and seasonal influenza all appear to be independently associated with in-hospital mortality, but to varying degrees in the current sample. These findings may guide hospital administrators as they consider factors that influence weekly and seasonal patient flow and capacity, as well as staffing.

摘要

背景

医院入住率、护士人员配备水平、周末入院和季节性流感均与院内死亡率相关。然而，尚无研究同时比较这 4 个因素与院内死亡率之间关联的强度。

目的

比较高医院入住率、增加护士人员配备水平、周末入院和季节性流感对入院时院内死亡率的影响。

研究设计

对密歇根州 39 家医院 2003 年至 2006 年期间收治的 166920 例患者进行回顾性队列研究。参与者为年龄≥65 岁、通过急诊入院、有 6 种常见出院诊断（急性心肌梗死、充血性心力衰竭、中风、肺炎、髋部骨折、胃肠道出血）的成年人。我们使用逻辑回归比较了 4 种因素各自对死亡预测概率的影响差异，同时控制了患者年龄、性别、出院诊断和合并症。

结果

这 4 个因素均与院内死亡率有统计学意义的独立关联。季节性流感导致院内死亡率的绝对风险增加最大（0.5 个百分点；95%CI，0.23-0.76），其次是周末入院（0.32，0.11-0.54）和入院时的高医院入住率（0.24，0.06-0.43）。增加护士人员配备水平可使每个患者每天每增加 1 名全职护士时的死亡率绝对风险降低 0.25 个百分点（0.04-0.48）。