Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA.
Crit Care Med. 2024 Feb 1;52(2):182-189. doi: 10.1097/CCM.0000000000006066. Epub 2024 Jan 19.
In the context of traditional nurse-to-patient ratios, ICU patients are typically paired with one or more copatients, creating interdependencies that may affect clinical outcomes. We aimed to examine the effect of copatient illness severity on ICU mortality.
We conducted a retrospective cohort study using electronic health records from a multihospital health system from 2018 to 2020. We identified nurse-to-patient assignments for each 12-hour shift using a validated algorithm. We defined copatient illness severity as whether the index patient's copatient received mechanical ventilation or vasoactive support during the shift. We used proportional hazards regression with time-varying covariates to assess the relationship between copatient illness severity and 28-day ICU mortality.
Twenty-four ICUs in eight hospitals.
Patients hospitalized in the ICU between January 1, 2018, and August 31, 2020.
None.
The main analysis included 20,650 patients and 84,544 patient-shifts. Regression analyses showed a patient's risk of death increased when their copatient received both mechanical ventilation and vasoactive support (hazard ratio [HR]: 1.30; 95% CI, 1.05-1.61; p = 0.02) or vasoactive support alone (HR: 1.82; 95% CI, 1.39-2.38; p < 0.001), compared with situations in which the copatient received neither treatment. However, if the copatient was solely on mechanical ventilation, there was no significant increase in the risk of death (HR: 1.03; 95% CI, 0.86-1.23; p = 0.78). Sensitivity analyses conducted on cohorts with varying numbers of copatients consistently showed an increased risk of death when a copatient received vasoactive support.
Our findings suggest that considering copatient illness severity, alongside the existing practice of considering individual patient conditions, during the nurse-to-patient assignment process may be an opportunity to improve ICU outcomes.
在传统的护士与患者比例的情况下，重症监护病房（ICU）的患者通常与一名或多名共同患者配对，这会产生相互依存关系，可能会影响临床结果。我们旨在研究共同患者疾病严重程度对 ICU 死亡率的影响。
我们使用来自 2018 年至 2020 年多医院医疗系统的电子健康记录进行了回顾性队列研究。我们使用经过验证的算法识别每个 12 小时轮班的护士与患者分配情况。我们将共同患者疾病严重程度定义为指数患者的共同患者在轮班期间是否接受机械通气或血管活性支持。我们使用具有时变协变量的比例风险回归来评估共同患者疾病严重程度与 28 天 ICU 死亡率之间的关系。
八家医院的 24 个 ICU。
2018 年 1 月 1 日至 2020 年 8 月 31 日期间在 ICU 住院的患者。
无。
主要分析包括 20650 名患者和 84544 名患者轮次。回归分析显示，当共同患者接受机械通气和血管活性支持（危险比[HR]：1.30；95%置信区间[CI]，1.05-1.61；p=0.02）或仅接受血管活性支持（HR：1.82；95% CI，1.39-2.38；p<0.001）时，患者死亡的风险增加，与共同患者未接受任何治疗的情况相比。然而，如果共同患者仅接受机械通气，则死亡风险没有显著增加（HR：1.03；95% CI，0.86-1.23；p=0.78）。在共同患者数量不同的队列中进行的敏感性分析一致显示，当共同患者接受血管活性支持时，死亡风险增加。
我们的研究结果表明，在护士与患者分配过程中，除了考虑现有个体患者病情外，还应考虑共同患者的疾病严重程度，这可能是改善 ICU 结果的机会。
