Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Global Health Nursing, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
J Clin Nurs. 2022 Sep;31(17-18):2562-2573. doi: 10.1111/jocn.16075. Epub 2021 Oct 24.
To examine the non-linear dose-response associations between nurse staffing levels and patient outcomes using a nationwide inpatient database in Japan.
Previous studies showed that higher nurse staffing levels were associated with better patient outcomes. However, it remains unclear whether there are thresholds for the associations between higher nurse staffing levels and improved patient outcomes.
Retrospective observational study design following the STROBE guideline.
We identified all patients aged ≥20 years who underwent one of six major cancer surgeries between July 2010 and March 2018 using data from the Diagnosis Procedure Combination database, a nationwide database for acute-care inpatients in Japan. Restricted cubic spline regression analyses, the statistical method that allows non-linear functional form, were performed with several scenarios of cut-off points to examine the dose-response associations between patient-to-nurse ratio per shift and failure to rescue, 30-day in-hospital mortality and postoperative complications.
Among 645,687 patients, restricted cubic spline regression analyses showed insignificant associations of patient-to-nurse ratio with failure to rescue and 30-day in-hospital mortality with no threshold, but a reverse J-shaped association with postoperative complications with a threshold of patient-to-nurse ratio per shift of 5.4.
In terms of postoperative complications, additional registered nurses were associated with decreased postoperative complications. However, this incremental benefit of additional registered nurses may disappear if hospitals allocate five to six number of registered nurses in general wards.
This study suggested that additional registered nurses over one per five to six patients may not bring the incremental benefit to decrease postoperative complications.
利用日本全国住院患者数据库，研究护士配置水平与患者结局之间的非线性剂量反应关系。
先前的研究表明，较高的护士配置水平与更好的患者结局相关。然而，目前尚不清楚较高的护士配置水平与改善患者结局之间是否存在关联的阈值。
遵循 STROBE 指南的回顾性观察研究设计。
我们使用日本急性住院患者全国数据库——诊断程序组合数据库的数据，确定了 2010 年 7 月至 2018 年 3 月期间接受六种主要癌症手术之一的所有年龄≥20 岁的患者。使用限制三次样条回归分析，这种统计方法允许非线性函数形式，对每个班次的患者与护士比例与抢救失败、30 天院内死亡率和术后并发症之间的剂量反应关系进行了几种截断点的分析。
在 645687 名患者中，限制三次样条回归分析显示，患者与护士比例与抢救失败和 30 天院内死亡率之间没有显著关联，也没有关联的阈值，但与术后并发症之间存在反向 J 形关联，其阈值为每班患者与护士比例为 5.4。
就术后并发症而言，增加注册护士的数量与减少术后并发症相关。然而，如果医院在普通病房中分配五到六名注册护士，那么额外增加注册护士的这种增量效益可能会消失。
本研究表明，每五到六名患者增加一名以上的注册护士可能不会带来减少术后并发症的增量效益。
