PhD, RN, Director, Department of Nursing, China Medical University Hospital, and Adjunct Assistant Professor, Department of Nursing, China Medical University.
MSN, RN, Department of Nursing, Taichung Veterans General Hospital.
J Nurs Res. 2019 Feb;27(1):1-9. doi: 10.1097/jnr.0000000000000265.
Nursing workload is highly associated with patient safety. It has been argued that the imbalance between nursing payment and nursing workload in Taiwan National Health Insurance (NHI)-covered intensive care units (ICUs) has resulted in the inadequate allocation of nursing manpower. However, limited empirical data are currently available to support this argument.
The aim of this study was to investigate the correlation between nursing workload, quality of care, and NHI-covered nursing payments in ICU settings.
This macrodata analysis study retrieved data from the existing ICU patient classification system, nursing quality monitoring system, and infection control monitoring system of a medical center in central Taiwan. Data on the Therapeutic Intervention Scoring System-28 (TISS-28) and non-TISS-28 scores, nursing hours, and nursing labor utilization rate were retrieved for the 23-month period beginning in January 2013 and ending in November 2014. The indices of care quality used in this study included incidence of falls, pressure sore density, incidence of restraint use, incidence of tube self-extraction, and infection density.
A total of 92,442 data sets were collected from eight ICUs, with 61% of the direct ICU nursing hours categorized as TISS-28 and 39% categorized as non-TISS-28. Mean nursing hours totaled 12.5 hours. The direct nursing hours, the total nursing hours, the bed occupancy rate, the nursing hours calculated by patient classification system, and the nursing hours calculated by nurse-patient ratio were statistically, significantly correlated respectively with all of the care quality indices except for incidence of falls. The number of items of patient care in the patient classification records was greater than that of NHI-covered nursing payments. The NHI-covered nursing payment for every patient accounted for only 4.77% of the total medical expenses in the ICU.
CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Data from the patient classification database, quality monitoring database, and medical cost database indicate excessive nursing workload and underpayment from the Taiwan NHI program. Current nursing workload was significantly associated with care quality. This study provides empirical data for administrators to consider when revising nursing staffing and NHI payment policies.
护理工作量与患者安全高度相关。有人认为，在台湾全民健康保险（NHI）覆盖的重症监护病房（ICU）中，护理薪酬与护理工作量之间的不平衡导致护理人力配置不足。然而，目前可用的经验数据有限，无法支持这一观点。
本研究旨在调查 ICU 环境中护理工作量、护理质量与 NHI 覆盖的护理支付之间的相关性。
本宏数据分析研究从台湾中部一家医学中心的 ICU 患者分类系统、护理质量监测系统和感染控制监测系统中提取数据。检索了 2013 年 1 月至 2014 年 11 月 23 个月的 TISS-28 和非 TISS-28 评分、护理时间和护理劳动利用率数据。本研究使用的护理质量指标包括跌倒发生率、压疮密度、约束使用率、导管自行拔出发生率和感染密度。
从 8 个 ICU 共收集了 92442 组数据，其中 61%的直接 ICU 护理时间被归类为 TISS-28，39%被归类为非 TISS-28。平均护理时间为 12.5 小时。直接护理时间、总护理时间、床位占用率、按患者分类系统计算的护理时间和按护士-患者比例计算的护理时间与除跌倒发生率外的所有护理质量指标均呈统计学显著相关。患者分类记录中的护理项目数多于 NHI 覆盖的护理支付数。每位患者的 NHI 覆盖护理支付仅占 ICU 总医疗费用的 4.77%。
结论/对实践的启示：来自患者分类数据库、质量监测数据库和医疗费用数据库的数据表明，台湾 NHI 计划的护理工作量过大且支付不足。当前的护理工作量与护理质量显著相关。本研究为管理者在修订护理人员配置和 NHI 支付政策时提供了经验数据。
