Nursing Executive Department, Catalan Institute of Health, Barcelona, Catalonia, Spain.
Nursing Research Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Catalonia, Spain.
J Nurs Manag. 2019 Nov;27(8):1845-1858. doi: 10.1111/jonm.12885. Epub 2019 Oct 30.
To assess the ability of the patient main problem to predict acuity in adults admitted to hospital wards and step-down units.
Acuity refers to the categorization of patients based on their required nursing intensity. The relationship between acuity and nurses' clinical judgment on the patient problems, including their prioritization, is an underexplored issue.
Cross-sectional, multi-centre study in a sample of 200,000 adults. Multivariate analysis of main problems potentially associated with acuity levels higher than acute was performed. Distribution of patients and outcome differences among acuity clusters were evaluated.
The main problems identified are strongly associated with patient acuity. The model exhibits remarkable ability to predict acuity (AUC, 0.814; 95% CI, 0.81-0.816). Most patients (64.8%) match higher than acute categories. Significant differences in terms of mortality, hospital readmission and other outcomes are observed (p < .005).
The patient main problem predicts acuity. Most inpatients require more intensive than acute nursing care and their outcomes are adversely affected.
Prospective measurement of acuity, considering nurses' clinical judgments on the patient main problem, is feasible and may contribute to support nurse management workforce planning and staffing decision-making, and to optimize patients, nurses and organizational outcomes.
评估患者主要问题预测成人住院病房和下病房患者病情严重程度的能力。
病情严重程度是指根据患者所需护理强度对患者进行分类。病情严重程度与护士对患者问题的临床判断之间的关系，包括对这些问题的优先排序，是一个尚未充分探讨的问题。
对 20 万成年人进行横断面、多中心研究。对可能与高于急症的严重程度水平相关的主要问题进行多变量分析。评估患者的分布情况以及不同严重程度组之间的结局差异。
确定的主要问题与患者病情严重程度密切相关。该模型对病情严重程度的预测能力很强（AUC，0.814；95%CI，0.81-0.816）。大多数患者（64.8%）属于高于急症的类别。在死亡率、医院再入院和其他结局方面观察到显著差异（p<.005）。
患者的主要问题可预测病情严重程度。大多数住院患者需要比急症更强化的护理，其结局受到不利影响。
考虑护士对患者主要问题的临床判断，前瞻性地测量病情严重程度是可行的，可能有助于支持护士管理劳动力规划和人员配置决策，并优化患者、护士和组织结局。
