Larson Elaine L, Cohen Bevin, Liu Jianfang, Zachariah Philip, Yao David, Shang Jingjing
Author Affiliations: School of Nursing (Drs Larson, Liu, and Shang and Ms Cohen) and Mailman School of Public Health (Dr Larson), College of Physicians and Surgeons (Dr Zachariah), and Department of Industrial Engineering and Operations Research (Dr Yao), Columbia University.
Comput Inform Nurs. 2017 Dec;35(12):617-623. doi: 10.1097/CIN.0000000000000375.
Although previous research has confirmed that nurse staffing affects patient outcomes, some potentially important factors have not been accounted for in tools to assess relationships between staffing and outcomes. The aim of this project was to develop and test a Nursing Intensity of Care Index using electronically available data from 152 072 patient discharges from three hospitals. Initially, 1765 procedure codes were reviewed; 69 were confirmed as directly increasing nursing workload by at least 15 minutes per shift. Two research staff independently reviewed a random sample of 5 patient days to assess interrater reliability with complete scoring agreement. To assess face validity, eight nurse clinician experts reviewed factors included in the Nursing Intensity of Care Index to assess the accuracy of the nursing time estimates in the tool. To examine concurrent validity, Nursing Intensity of Care Index scores for a random sample of 28 patients from four clinical units were compared with assessments made by a unit-based clinical nurse (low/medium/high intensity) for the same patients on the same day with a Spearman correlation of 0.94. In preliminary testing, data for the Nursing Intensity of Care Index, which accurately reflect nursing care intensity, can be obtained electronically in real time. The next steps will be a discrete-event simulation model and large-scale field trials.
尽管先前的研究已经证实护士配备情况会影响患者的治疗结果，但在评估配备情况与治疗结果之间关系的工具中，一些潜在的重要因素并未得到考虑。本项目的目的是利用来自三家医院152072例患者出院的电子数据，开发并测试护理强度指数。最初，对1765个程序代码进行了审查；其中69个被确认为每班至少直接增加15分钟的护理工作量。两名研究人员独立审查了5个随机抽取的患者日样本，以评估评分者间的可靠性，结果完全达成评分一致。为了评估表面效度，八位护士临床专家审查了护理强度指数中包含的因素，以评估该工具中护理时间估计的准确性。为了检验同时效度，将来自四个临床科室的28例随机抽取患者的护理强度指数得分，与同一日由科室临床护士对相同患者进行的评估（低/中/高强度）进行比较，斯皮尔曼相关性为0.94。在初步测试中，可以实时以电子方式获取准确反映护理强度的护理强度指数数据。接下来的步骤将是建立离散事件模拟模型并进行大规模现场试验。
