Kim Yunmi, Kim Hyun-Young, Cho Eunyoung
1College of Nursing, Eulji University, 553 Sanseong-daero, Sujeong-gu, Seongnam-si, 13135 Republic of Korea.
2Department of Nursing, Jeonju University, 303 Cheonjam-ro, Wansan-gu, Jeonju-si, 55069 Republic of Korea.
BMC Nurs. 2020 Mar 17;19:17. doi: 10.1186/s12912-020-0410-7. eCollection 2020.
The likelihood of inpatient mortality has been found to be reduced by increased nurse staffing in several settings, including general wards, emergency departments, and intensive care units. However, less research has investigated cases where patients die in the community setting due to a health problem that occurred after they were discharged post-surgery, because it is difficult to integrate hospital data and local community data. Therefore, this study investigated the association between the bed-to-nurse ratio and 30-day post-discharge mortality in patients undergoing surgery using national administrative data.
The study analyzed data from 129,923 patients who underwent surgery between January 2014 and December 2015. The bed-to-nurse ratio was categorized as level 1 (less than 2.5), level 2 (2.5-3.4), level 3 (3.5-4.4), and level 4 (4.5 or greater). The chi-square test and GEE logistic regression analyses were used to explore the association between the bed-to-nurse ratio and 30-day post-discharge mortality.
1355 (0.01%) patients died within 30 days post-discharge. The 30-day post-discharge mortality rate in hospitals with a level 4 was 2.5%, representing a statistically significant difference from the rates of 0.8, 2 and 1.8% in hospitals with level 1, level 2, and level 3 staffing, respectively. In addition, the death rate was significantly lower at hospitals with a level 1 (OR = 0.62) or level 2 (OR = 0.63) bed-to-nurse ratio, using level 4 as reference.
The results of this study are highly meaningful in that they underscore the necessity of in-hospital discharge nursing and continued post-discharge nursing care as a way to reduce post-discharge mortality risk. Furthermore, the relationship between nurse staffing levels and 30-day post-discharge mortality implies the need for a greater focus on discharge education. Policies are required to achieve proper nurse staffing levels in Korea, and thereby to enhance patient outcomes.
在包括普通病房、急诊科和重症监护病房在内的多种环境中，增加护士配备已被发现可降低住院患者的死亡率。然而，由于难以整合医院数据和当地社区数据，较少有研究调查患者在手术后出院因健康问题在社区环境中死亡的情况。因此，本研究利用国家行政数据调查了手术患者的床位与护士比例和出院后30天死亡率之间的关联。
该研究分析了2014年1月至2015年12月期间接受手术的129923例患者的数据。床位与护士比例分为1级（低于2.5）、2级（2.5 - 3.4）、3级（3.5 - 4.4）和4级（4.5或更高）。采用卡方检验和广义估计方程逻辑回归分析来探讨床位与护士比例和出院后30天死亡率之间的关联。
1355例（0.01%）患者在出院后30天内死亡。4级医院的出院后30天死亡率为2.5%，与1级、2级和3级人员配备医院的死亡率分别为0.8%、2%和1.8%相比，具有统计学显著差异。此外，以4级为参照，1级（OR = 0.62）或2级（OR = 0.63）床位与护士比例的医院死亡率显著较低。
本研究结果具有重要意义，因为它们强调了住院出院护理和出院后持续护理作为降低出院后死亡风险方法的必要性。此外，护士配备水平与出院后30天死亡率之间的关系意味着需要更加关注出院教育。韩国需要制定政策以实现适当护士配备水平，从而改善患者结局。
