Department of Orthopaedic Surgery, University of Michigan, 2912 Taubman Center, Ann Arbor, MI 48109-5328, USA.
Clin Orthop Relat Res. 2011 Oct;469(10):2932-40. doi: 10.1007/s11999-011-1917-8. Epub 2011 May 18.
There is increasing recognition that lower nurse staffing levels are associated with higher morbidity and mortality among medical and surgical patients. The degree to which this applies to elderly patients with hip fractures is unclear.
QUESTIONS/PURPOSES: We conducted a pilot study using administrative data as an initial step in investigating the relationship between nurse staffing levels and in-hospital mortality among elderly patients with hip fractures.
We retrospectively reviewed administrative data for 13,343 patients 65 years or older with a primary diagnosis of hip fracture admitted to 39 Michigan hospitals between 2003 and 2006. We used logistic regression to calculate the change in predicted probability of in-hospital death conferred by differences in the hospitals' overall number of full-time equivalent registered nursing staff (FTE-RN) per patient day. Regression models controlled for patient age, gender, and comorbid conditions; hospital characteristics including teaching status, hip fracture volume, and income/racial composition of the hospital's zip code; and seasonal influenza.
We found an association between hospital-wide nurse staffing levels and in-hospital mortality among patients with hip fractures. The odds of in-hospital mortality decreased by 0.16 for every additional FTE-RN added per patient day, even after controlling for covariates. This association suggests the absolute risk of mortality increases by 0.35 percentage points for every one unit decrease of FTE-RN per patient day, a 16% increase in the risk of death.
Decreased hospital-wide nurse staffing levels are associated with increased in-hospital mortality among patients admitted with hip fractures. These observations indicate the need for further studies to characterize this relationship for staffing of units caring for patients with hip fractures.
Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
越来越多的人认识到，较低的护士配备水平与医疗和外科患者的发病率和死亡率较高有关。这种情况在老年髋部骨折患者中适用的程度尚不清楚。
问题/目的：我们使用行政数据进行了一项初步研究，以初步调查护士配备水平与老年髋部骨折患者住院死亡率之间的关系。
我们回顾性分析了 2003 年至 2006 年间 39 家密歇根州医院收治的 13343 名年龄在 65 岁或以上、主要诊断为髋部骨折的患者的行政数据。我们使用逻辑回归计算了医院每患者日总全职等效注册护士人数（FTE-RN）差异所带来的住院死亡预测概率的变化。回归模型控制了患者年龄、性别和合并症；医院特征，包括教学地位、髋部骨折量以及医院邮政编码的收入/种族构成；以及季节性流感。
我们发现医院范围内的护士配备水平与髋部骨折患者的住院死亡率之间存在关联。即使在控制了协变量后，每增加每患者日 1 个 FTE-RN，住院死亡率的几率就会降低 0.16。这种关联表明，每减少每患者日 FTE-RN 1 个单位，绝对死亡率就会增加 0.35 个百分点，死亡率增加 16%。
医院范围内护士配备水平的降低与髋部骨折患者的住院死亡率增加有关。这些观察结果表明，需要进一步研究来描述髋部骨折患者护理单位人员配备的这种关系。
三级，预后研究。有关证据水平的完整描述，请参见作者指南。
