King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
J Psychiatr Ment Health Nurs. 2019 Nov;26(9-10):337-346. doi: 10.1111/jpm.12545. Epub 2019 Jul 25.
WHAT IS KNOWN ON THE SUBJECT?: Literature on staffing levels and outcomes in psychiatric wards is limited and shows mixed associations Lack of economic evidence on conflicts and containment in psychiatric care Data from the City-128 study showed that regular qualified nurse staffing levels in the preceding shifts were associated with raised conflict and containment levels WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first economic analysis using the City-128 data, with costs and outcomes data have been combined. Cost-effectiveness of different staffing levels in relation to conflicts and containments in England, using data from the City-128 study Both day and night shifts appeared to show that the low staff scenario was cost-effective in terms of conflicts and containment averted, even after attempts were made to adjust for patient severity WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This paper could be an indication towards further investigation into how mental health inpatient care, specially nursing is organized in England. Abstract Introduction Evidence from City-128 study shows a positive association between staffing levels and conflicts/containment. Economic evidence on this topic is scarce, with no economic analyses combining costs and outcomes. Aim/Question To assess the cost-effectiveness of different staffing levels in relation to conflicts and containments in England, using City-128 study data. Methods Shifts were grouped into three groups based on staff-to-bed ratio. Cost information was combined with total conflicts and containment measures to assess cost-effectiveness. Results The cost-effectiveness analysis of the three staffing scenarios for both day and night shifts appeared to show that the low staff scenario was cost-effective in terms of conflicts and containment averted, even adjusting for patient severity. A production function analysis also revealed that increased staff numbers were associated with higher numbers of events. Discussion Causation cannot be attributed and neither can recommendations be made on optimal staffing levels. The impact on other outcomes such as symptoms, functioning and length of stay, and other factors should be explored, and these may all benefit from increased staff numbers. Implications for practice These results indicate that increasing staff numbers may not necessarily improve conflict and containment outcomes. They may produce positive outcomes in other domains.
关于精神科病房人员配备水平和结果的文献有限，且显示出混合关联 缺乏关于精神科护理冲突和约束的经济证据 City-128 研究的数据表明，前一班次的常规合格护士配备水平与较高的冲突和约束水平相关联 本研究的新发现： 这是首次使用 City-128 数据进行经济分析，已将成本和结果数据结合在一起。 使用 City-128 研究的数据，研究英格兰不同人员配备水平与冲突和约束之间的成本效益 日间和夜间班次似乎都表明，从避免冲突和约束的角度来看，低人员配置方案具有成本效益，即使在尝试调整患者严重程度后也是如此 对实践的影响： 本文可能表明需要进一步调查英格兰精神科住院护理，特别是护理人员的组织方式。 摘要 引言 City-128 研究的证据表明人员配备水平与冲突/约束之间存在正相关关系。 关于这个主题的经济证据很少，没有将成本和结果结合在一起的经济分析。 目的/问题 利用 City-128 研究数据评估英格兰不同人员配备水平与冲突和约束之间的成本效益。 方法 根据员工与床位的比例将班次分为三组。 结合成本信息和总冲突和约束措施来评估成本效益。 结果 日间和夜间班次的三种人员配备方案的成本效益分析似乎表明，即使调整了患者严重程度，低人员配置方案在避免冲突和约束方面也具有成本效益。 生产函数分析还表明，员工人数的增加与事件数量的增加相关。 讨论 不能归因于因果关系，也不能就最佳人员配备水平提出建议。 应探讨其他结果（如症状、功能和住院时间）以及其他因素的影响，这些因素可能都受益于员工人数的增加。 对实践的影响 这些结果表明，增加员工人数不一定能改善冲突和约束的结果。 它们可能会在其他领域产生积极的结果。
