医院护士配备与患者安全：新的变量和纵向研究方法。
Nurse staffing and patient safety in hospitals: new variable and longitudinal approaches.
机构信息
Health Services Administration, Department of Health Management and Informatics, College of Health and Public Affairs, University of Central Florida, Orlando, FL 32816-2205, USA.
出版信息
Nurs Res. 2012 Jan-Feb;61(1):3-12. doi: 10.1097/NNR.0b013e3182358968.
BACKGROUND
Most studies of the relationship between nurse staffing and patient outcomes in hospitals have shown that worse patient outcomes are associated with lower registered nurse (RN) staffing. However, inconsistent results exist, possibly because of the use of a variety of nurse staffing and patient outcomes measures and because of statistical methods that employ static, instead of change, relationships.
OBJECTIVES
The aim of the study was to examine the relationship between changes in RN staffing and patient safety events in Florida hospitals from 1996 through 2004.
METHODS
Using 9 years of data from 124 Florida hospitals, latent growth curve models were used to assess the impact on patient safety of RN staffing changes in hospitals. Patient safety measures were 4 of the 20 provider-level patient safety indicators (PSIs) developed by the Agency for Healthcare Research and Quality. Two measures of RN staffing-RN full-time equivalents and RN per adjusted patient day-were analyzed.
RESULTS
Changes in RN full-time equivalents were positively related to changes in RN per adjusted patient day. All PSIs were negatively and significantly related to one or both RN staffing measures. Failure to rescue had the strongest relationship to RN staffing. Models of change relationships between staffing and PSIs were more likely to show significant relationships than models using initial levels. Initial levels of RN staffing tended to be unrelated to initial levels of PSIs.
DISCUSSION
A negative relationship between RN staffing and PSIs was strongly supported with failure to rescue and was weakly supported with decubitus ulcers, selected infections, and postoperative sepsis. The PSIs should be retested in an expanded change model study using multistate or national sample Healthcare Cost and Utilization Project data.
背景
大多数研究表明，医院的护士人员配备与患者预后之间存在关联，即患者预后较差与注册护士（RN）人员配备不足有关。然而，研究结果并不一致，这可能是由于使用了各种护士人员配备和患者预后的衡量标准，以及采用了静态而不是变化关系的统计方法。
目的
本研究旨在检验佛罗里达州医院 1996 年至 2004 年间注册护士人员配备变化与患者安全事件之间的关系。
方法
利用来自 124 家佛罗里达州医院的 9 年数据，使用潜在增长曲线模型评估医院注册护士人员配备变化对患者安全的影响。患者安全指标使用的是医疗机构质量改进机构开发的 20 个提供者级别的患者安全指标中的 4 个。分析了两种护士人员配备衡量标准，即注册护士全职当量和每调整患者日的注册护士人数。
结果
注册护士全职当量的变化与每调整患者日的注册护士人数的变化呈正相关。所有患者安全指标都与一个或两个护士人员配备衡量标准呈负相关且具有统计学意义。未能抢救与护士人员配备的关系最强。人员配备和 PSI 之间变化关系的模型比使用初始水平的模型更有可能显示出显著的关系。初始护士人员配备水平与初始 PSI 水平之间往往没有关系。
讨论
注册护士人员配备与 PSI 之间的负相关关系在未能抢救方面得到了强有力的支持，在压疮、选择感染和术后败血症方面得到了较弱的支持。应使用多州或全国样本医疗保健成本和利用项目数据的扩展变化模型研究重新测试 PSI。
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