Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
BMJ Qual Saf. 2019 Aug;28(8):609-617. doi: 10.1136/bmjqs-2018-008043. Epub 2018 Dec 4.
To determine the association between daily levels of registered nurse (RN) and nursing assistant staffing and hospital mortality.
This is a retrospective longitudinal observational study using routinely collected data. We used multilevel/hierarchical mixed-effects regression models to explore the association between patient outcomes and daily variation in RN and nursing assistant staffing, measured as hours per patient per day relative to ward mean. Analyses were controlled for ward and patient risk.
138 133 adult patients spending >1 days on general wards between 1 April 2012 and 31 March 2015.
In-hospital deaths.
Hospital mortality was 4.1%. The hazard of death was increased by 3% for every day a patient experienced RN staffing below ward mean (adjusted HR (aHR) 1.03, 95% CI 1.01 to 1.05). Relative to ward mean, each additional hour of RN care available over the first 5 days of a patient's stay was associated with 3% reduction in the hazard of death (aHR 0.97, 95% CI 0.94 to 1.0). Days where admissions per RN exceeded 125% of the ward mean were associated with an increased hazard of death (aHR 1.05, 95% CI 1.01 1.09). Although low nursing assistant staffing was associated with increases in mortality, high nursing assistant staffing was also associated with increased mortality.
Lower RN staffing and higher levels of admissions per RN are associated with increased risk of death during an admission to hospital. These findings highlight the possible consequences of reduced nurse staffing and do not give support to policies that encourage the use of nursing assistants to compensate for shortages of RNs.
确定注册护士（RN）和护理助理人员配置的日常水平与医院死亡率之间的关系。
这是一项使用常规收集数据的回顾性纵向观察研究。我们使用多水平/分层混合效应回归模型来探索患者结局与 RN 和护理助理人员配置的日常变化之间的关系，该变化以每天每个患者相对于病房平均值的每小时数来衡量。分析控制了病房和患者风险。
2012 年 4 月 1 日至 2015 年 3 月 31 日期间在普通病房住院>1 天的 138133 名成年患者。
住院死亡。
医院死亡率为 4.1%。与病房平均值相比，患者每天经历的 RN 人员配备低于病房平均值，死亡风险增加 3%（调整后的 HR（aHR）1.03，95%CI 1.01 至 1.05）。与病房平均值相比，患者住院前 5 天每增加 1 小时的 RN 护理，死亡风险降低 3%（aHR 0.97，95%CI 0.94 至 1.0）。每天每 1 名 RN 护理的患者人数超过病房平均值的 125%，与死亡风险增加相关（aHR 1.05，95%CI 1.01 至 1.09）。虽然低护理助理人员配备与死亡率增加相关，但高护理助理人员配备也与死亡率增加相关。
RN 人员配备减少和每 1 名 RN 护理的患者人数增加与住院期间死亡风险增加相关。这些发现强调了减少护士人员配备可能带来的后果，并且不支持鼓励使用护理助理来弥补 RN 短缺的政策。
