National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex), University of Southampton, Southampton, UK.
Faculty of Health Sciences, University of Southampton, Southampton, UK.
J Nurs Manag. 2019 Apr;27(3):502-508. doi: 10.1111/jonm.12704. Epub 2018 Nov 21.
AIM: To evaluate whether ≥12-hr shifts are associated with a decrease in resource use, in terms of care hours per patient day and staffing costs per patient day. BACKGROUND: Nurses working long shifts may become less productive and no research has investigated whether potential cost savings are realized. METHOD: A retrospective longitudinal study using routinely collected data from 32 wards within an English hospital across 3 years (1 April 2012-31 March 2015). There were 24,005 ward-days. Hierarchical linear mixed models measured the association between the proportion of ≥12-hr shifts worked on a ward-day, care hours per patient day and staffing costs per patient day. RESULTS: Compared with days with no ≥12-hr shifts, days with between 50% and 75% ≥12-hr shifts had more care hours per patient day and higher costs (estimate for care hours per patient day: 0.32; 95% CI: 0.28-0.36; estimate for staffing costs per patient day: £8.86; 95% CI: 7.59-10.12). CONCLUSIONS: We did not find reductions in total care hours and costs associated with the use of ≥12-hr shifts. The reason why mixed shift patterns are associated with increased cost needs further exploration. IMPLICATIONS FOR NURSING MANAGEMENT: Increases in resource use could result in additional costs or loss of productivity for hospitals. Implementation of long shifts should be questioned.
目的:评估≥12 小时班次是否与患者护理时数和患者日人力成本的减少有关。
背景:长时间轮班的护士可能效率降低,但目前还没有研究调查是否可以实现潜在的成本节约。
方法:这是一项使用英格兰一家医院 32 个病房的常规数据进行的回顾性纵向研究,研究时间跨度为 3 年(2012 年 4 月 1 日至 2015 年 3 月 31 日),共涉及 24005 个病房日。采用分层线性混合模型,分析病房日≥12 小时班次比例与患者护理时数和患者日人力成本之间的关系。
结果:与没有≥12 小时班次的日子相比,有 50%至 75%≥12 小时班次的日子患者护理时数更多,成本更高(患者护理时数的估计值:0.32;95%CI:0.28-0.36;患者日人力成本的估计值:£8.86;95%CI:7.59-10.12)。
结论:我们没有发现与使用≥12 小时班次相关的总护理时数和成本减少。需要进一步探讨混合班次模式与成本增加之间的关系。
启示:资源使用的增加可能会导致医院增加成本或降低生产力。应质疑长时间轮班的实施。
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