护士人力配置对患者结局的影响：安全网医院和非安全网医院。

Nurse staffing effects on patient outcomes: safety-net and non-safety-net hospitals.

机构信息

Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA.

出版信息

Med Care. 2011 Apr;49(4):406-14. doi: 10.1097/MLR.0b013e318202e129.

DOI:10.1097/MLR.0b013e318202e129

PMID:21407034

Abstract

BACKGROUND

Nurse staffing has been linked to hospital patient outcomes; however, previous results were inconsistent because of variations in measures of staffing and were only rarely specific to types of patient care units.

OBJECTIVE

To determine the relationship between nurse staffing in general and intensive care units and patient outcomes and determine whether safety net status affects this relationship.

RESEARCH DESIGN

A cross-sectional design used data from hospitals belonging to the University HealthSystem Consortium.

SUBJECTS

Data were available for approximately 1.1 million adult patient discharges and staffing for 872 patient care units from 54 hospitals.

MEASURES

Total hours of nursing care [Registered Nurses (RNs), Licensed Practical Nurses, and assistants] determined per inpatient day (TotHPD) and RN skill mix were the measures of staffing; Agency for Healthcare Research and Quality risk-adjusted safety and quality indicators were the outcome measures.

RESULTS

TotHPD in general units was associated with lower rates of congestive heart failure mortality (P<0.05), failure to rescue (P<0.10), infections (P<0.01), and prolonged length of stay (P<0.01). RN skill mix in general units was associated with reduced failure to rescue (P<0.01) and infections (P<0.05). TotHPD in intensive care units was associated with fewer infections (P<0.05) and decubitus ulcers (P<0.10). RN skill mix was associated with fewer cases of sepsis (P<0.01) and failure to rescue (P<0.05). Safety-net status was associated with higher rates of congestive heart failure mortality, decubitus ulcers, and failure to rescue.

CONCLUSIONS

Higher nurse staffing protected patients from poor outcomes; however, hospital safety-net status introduced complexities in this relationship.

摘要

背景

护士配备与医院患者结局相关；然而，由于人员配备措施的差异，之前的结果并不一致，且很少针对特定类型的患者护理单元。

目的

确定普通病房和重症监护病房护士配备与患者结局的关系，并确定安全网状况是否影响这种关系。

研究设计

使用来自大学卫生系统联合公司所属医院的数据，采用横断面设计。

研究对象

数据来自 54 家医院的约 110 万成年患者出院和 872 个患者护理单元的人员配备情况。

测量方法

每住院日护理时间（注册护士、执业护士和助理护士）[Registered Nurses (RNs), Licensed Practical Nurses, and assistants]和 RN 技能配比确定（TotHPD）是人员配备的衡量指标；医疗保健研究和质量局风险调整的安全和质量指标是结果衡量指标。

结果

普通病房 TotHPD 与充血性心力衰竭死亡率（P<0.05）、抢救失败（P<0.10）、感染（P<0.01）和住院时间延长（P<0.01）的发生率较低相关。普通病房 RN 技能配比与抢救失败（P<0.01）和感染（P<0.05）发生率降低相关。重症监护病房 TotHPD 与感染（P<0.05）和压疮（P<0.10）发生率较低相关。RN 技能配比与败血症（P<0.01）和抢救失败（P<0.05）的病例数减少相关。安全网状况与充血性心力衰竭死亡率、压疮和抢救失败的发生率较高相关。