围术期心脏骤停后患者生存与法定护士配置标准的关系：对韩国行政数据的横断面分析。

Relationship between the legal nurse staffing standard and patient survival after perioperative cardiac arrest: A cross-sectional analysis of Korean administrative data.

机构信息

School of Nursing, Eulji University, Seongnam, Republic of Korea.

School of Nursing, Gachon University, Incheon, Republic of Korea.

出版信息

Int J Nurs Stud. 2019 Jan;89:104-111. doi: 10.1016/j.ijnurstu.2018.09.012. Epub 2018 Oct 1.

DOI:10.1016/j.ijnurstu.2018.09.012

PMID:30359876

Abstract

BACKGROUND

Nurses play crucial roles in cardiopulmonary resuscitation after perioperative cardiac arrest (PCA), and the level of nurse staffing is thought to influence the survival rate for cardiac arrest. However, no previous study has investigated the survival rate after PCA in Korea. In addition, nurse staffing levels in Korea are relatively low and their legal standard is not widely followed.

OBJECTIVES

This study investigated the relationships between nurse staffing level and survival after PCA in Korean hospitals using inpatient National Health Insurance (NHI) claim data.

METHODS

The study used NHI claim data on patient and hospital characteristics for 2140 patients undergoing craniotomy or percutaneous angioplasty from January to December 2009. Because the information about nurse staffing in NHI claim data categorized nursing grade according to the nurse-to-bed ratio, the nurse staffing level was transformed from the nurse-to-patient ratio using the bed occupancy rate. The general ward and ICU nurse staffing levels were then categorized into major violation, violation, adherence, and major adherence according to the medical law standard. The association between nurse staffing level and survival after PCA was analyzed using logistic regression analyses with a generalized estimation model.

RESULTS

The survival rate was higher for patients in hospitals with major adherence [odds ratio (OR) = 1.53, 95% confidence interval (CI) = 1.13-2.07] ICUs nurse staffing than for those in hospitals with adherence nurse staffing, and lower for patients in hospitals with violation (OR = 0.50, 95% CI = 0.26-0.93) or major violation (OR = 0.45, 95% CI = 0.21-0.97) general ward nurse staffing than for those in hospitals with adherence nurse staffing. Policies to ensure adherence to the medical law standard for nurse staffing levels is necessary to enhance the safety of patients experiencing PCA in Korea.

摘要

背景

护士在围手术期心脏骤停（PCA）后的心肺复苏中发挥着至关重要的作用，护士人力配备水平被认为会影响心脏骤停患者的存活率。然而，之前没有研究调查过韩国 PCA 后的存活率。此外，韩国的护士人力配备水平相对较低，且其法律标准并未得到广泛遵守。

目的

本研究使用住院国民健康保险（NHI）理赔数据，调查了韩国医院护士人力配备水平与 PCA 后存活率之间的关系。

方法

本研究使用了 2009 年 1 月至 12 月期间接受开颅术或经皮血管成形术的 2140 名患者的 NHI 理赔数据，包括患者和医院特征。由于 NHI 理赔数据中的护士人力配备信息是根据护士与床位的比例对护理等级进行分类的，因此使用床位占用率将护士人力配备水平从护士与患者的比例转换而来。然后，根据医疗法标准，普通病房和 ICU 的护士人力配备水平被分为严重违规、违规、遵守和高度遵守。使用广义估计模型的逻辑回归分析来分析护士人力配备水平与 PCA 后存活率之间的关系。

结果

与遵守护士人力配备水平的医院相比，高度遵守护士人力配备水平 ICU 的医院患者存活率更高（比值比 [OR] = 1.53，95%置信区间 [CI] = 1.13-2.07），而违规（OR = 0.50，95% CI = 0.26-0.93）或严重违规（OR = 0.45，95% CI = 0.21-0.97）普通病房护士人力配备水平的医院患者存活率更低。为了提高韩国 PCA 患者的安全性，有必要制定政策确保遵守护士人力配备水平的医疗法标准。