West Elizabeth, Barron David N, Harrison David, Rafferty Anne Marie, Rowan Kathy, Sanderson Colin
Faculty of Education and Health, University of Greenwich, United Kingdom.
Saïd Business School and Jesus College, University of Oxford, United Kingdom.
Int J Nurs Stud. 2014 May;51(5):781-94. doi: 10.1016/j.ijnurstu.2014.02.007. Epub 2014 Feb 27.
To investigate whether the size of the workforce (nurses, doctors and support staff) has an impact on the survival chances of critically ill patients both in the intensive care unit (ICU) and in the hospital.
Investigations of intensive care outcomes suggest that some of the variation in patient survival rates might be related to staffing levels and workload, but the evidence is still equivocal.
Information about patients, including the outcome of care (whether the patient lived or died) came from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme. An Audit Commission survey of ICUs conducted in 1998 gave information about staffing levels. The merged dataset had information on 65 ICUs and 38,168 patients. This is currently the best available dataset for testing the relationship between staffing and outcomes in UK ICUs.
A cross-sectional, retrospective, risk adjusted observational study.
Multivariable, multilevel logistic regression.
ICU and in-hospital mortality.
After controlling for patient characteristics and workload we found that higher numbers of nurses per bed (odds ratio: 0.90, 95% confidence interval: [0.83, 0.97]) and higher numbers of consultants (0.85, [0.76, 0.95]) were associated with higher survival rates. Further exploration revealed that the number of nurses had the greatest impact on patients at high risk of death (0.98, [0.96, 0.99]) whereas the effect of medical staffing was unchanged across the range of patient acuity (1.00, [0.97, 1.03]). No relationship between patient outcomes and the number of support staff (administrative, clerical, technical and scientific staff) was found. Distinguishing between direct care and supernumerary nurses and restricting the analysis to patients who had been in the unit for more than 8h made little difference to the results. Separate analysis of in-unit and in-hospital survival showed that the clinical workforce in intensive care had a greater impact on ICU mortality than on hospital mortality which gives the study additional credibility.
This study supports claims that the availability of medical and nursing staff is associated with the survival of critically ill patients and suggests that future studies should focus on the resources of the health care team. The results emphasise the urgent need for a prospective study of staffing levels and the organisation of care in ICUs.
调查工作人员（护士、医生和辅助人员）的规模是否会对重症监护病房（ICU）及医院内重症患者的存活几率产生影响。
对重症监护结果的调查表明，患者存活率的部分差异可能与人员配备水平和工作量有关，但证据仍不明确。
有关患者的信息，包括护理结果（患者存活或死亡）来自重症监护国家审计与研究中心（ICNARC）病例组合计划。1998年审计委员会对ICU进行的一项调查提供了人员配备水平的信息。合并后的数据集包含65个ICU和38168名患者的信息。这是目前用于测试英国ICU人员配备与结果之间关系的最佳可用数据集。
一项横断面、回顾性、风险调整观察性研究。
多变量、多层次逻辑回归。
ICU死亡率和院内死亡率。
在控制患者特征和工作量后，我们发现每张病床护士数量较多（优势比：0.90，95%置信区间：[0.83，0.97]）以及顾问数量较多（0.85，[0.76，0.95]）与较高的存活率相关。进一步探究发现，护士数量对死亡高风险患者的影响最大（0.98，[0.96，0.99]），而医疗人员配备的影响在不同病情严重程度的患者中保持不变（1.00，[0.97，1.03]）。未发现患者结局与辅助人员（行政、文书、技术和科研人员）数量之间存在关联。区分直接护理护士和额外护士，并将分析限制在入住ICU超过8小时的患者，结果变化不大。对ICU内和院内存活情况的单独分析表明，重症监护中的临床工作人员对ICU死亡率的影响大于对医院死亡率的影响，这为该研究增添了可信度。
本研究支持医护人员的可获得性与重症患者存活相关的观点，并表明未来研究应聚焦于医疗团队的资源。结果强调迫切需要对ICU的人员配备水平和护理组织进行前瞻性研究。
