Department of Anesthesiology, University of Rochester School of Medicine, Rochester, NY, USA.
BMC Health Serv Res. 2012 Aug 9;12:247. doi: 10.1186/1472-6963-12-247.
The enormous fiscal pressures facing trauma centers may lead trauma centers to reduce nurse staffing and to make increased use of less expensive and less skilled personnel. The impact of nurse staffing and skill mix on trauma outcomes has not been previously reported. The goal of this study was to examine whether nurse staffing levels and nursing skill mix are associated with trauma patient outcomes.
We used data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample to perform a cross-sectional study of 70,142 patients admitted to 77 Level I and Level II centers. Logistic regression models were used to examine the association between nurse staffing measures and (1) mortality, (2) healthcare associated infections (HAI), and (3) failure-to-rescue. We controlled for patient risk factors (age, gender, injury severity, mechanism of injury, comorbidities) and hospital structural characteristics (trauma center status - Level I versus Level II, hospital size, ownership, teaching status, technology level, and geographic region).
A 1% increase in the ratio of licensed practical nurse (LPN) to total nursing time was associated with a 4% increase in the odds of mortality (adj OR 1.04; 95% CI: 1.02-1.06; p = 0.001) and a 6% increase in the odds of sepsis (adj OR 1.06: 1.03-1.10; p < 0.001). Hospitals in the highest quartile of LPN staffing had 3 excess deaths (95% CI: 1.2, 5.1) and 5 more episodes of sepsis (95% CI: 2.3, 7.6) per 1000 patients compared to hospitals in the lower quartile of LPN staffing.
Higher hospital LPN staffing levels are independently associated with slightly higher rates of mortality and sepsis in trauma patients admitted to Level I or Level II trauma centers.
创伤中心面临巨大的财政压力，这可能导致创伤中心减少护士配备，并增加使用成本更低、技能更差的人员。护士配备和技能组合对创伤结果的影响以前尚未报道过。本研究的目的是检查护士人员配备水平和护理技能组合是否与创伤患者的结局相关。
我们使用来自医疗保健成本和利用项目全国住院患者样本的数据，对 77 个一级和二级中心收治的 70142 名患者进行了一项横断面研究。使用逻辑回归模型检查护士人员配备措施与（1）死亡率、（2）医疗保健相关感染（HAI）和（3）救援失败之间的关联。我们控制了患者风险因素（年龄、性别、受伤严重程度、受伤机制、合并症）和医院结构特征（创伤中心状态-一级与二级、医院规模、所有权、教学状态、技术水平和地理位置）。
注册护士（LPN）与总护理时间之比每增加 1%，死亡率的几率增加 4%（调整后的比值比 1.04；95%可信区间：1.02-1.06；p=0.001），败血症的几率增加 6%（调整后的比值比 1.06；95%可信区间：1.03-1.10；p<0.001）。在 LPN 人员配备最高四分位数的医院中，每 1000 名患者中有 3 例额外死亡（95%可信区间：1.2，5.1）和 5 例以上败血症（95%可信区间：2.3，7.6）。
较高的医院 LPN 人员配备水平与一级或二级创伤中心收治的创伤患者的死亡率和败血症发生率略有升高独立相关。
