The Department of Neonatal Medicine, The Women's and Children's Hospital, Adelaide, South Australia, Australia.
The Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia.
J Paediatr Child Health. 2024 Oct;60(10):544-548. doi: 10.1111/jpc.16635. Epub 2024 Aug 6.
There is well-established data linking the adequacy of nurse staffing to patient outcomes. Evidence-based standards for staffing are therefore critical to drive improvements in clinical care. One such evidence-based approach is the use of patient acuity-based tools. The objective of this study is to determine the performance of a neonatal acuity tool in an Australian tertiary neonatal health-care setting, focusing on the classification of patient acuity and nursing:patient staffing ratios compared to current practice.
Acuity data were collected in a neonatal intensive care unit (NICU) and special care baby unit (SCBU) over a 10-week period in 2023. Patient data were scored in the 16 domains at two time points (prior to morning and evening nursing shift changeover) for all admitted newborns.
For ventilated newborns nursed with a nurse:patient staffing ratio of 1:1, 78% of scores were within the L4-high acuity (score ≥ 26) band, with the remaining scores within the L3-high acuity (18-25) band. For newborns on non-invasive respiratory support in NICU staffed 1:1, the proportion scoring within the L4 acuity band was higher in the nasal high-flow group compared to the nasal continuous positive airway pressure group (P = 0.032), an effect not seen for those nursed 1:2 in NICU or for those on nasal high-flow nursed in SCBU either 1:2 or 1:3.
This study of how a neonatal acuity classification system compares with current nurse:patient staffing allocations in an Australian tertiary NICU, suggests refinements in staffing ratios for specific patient groups on respiratory support are possible.
有充分的数据表明护士配置的充足程度与患者的治疗效果相关。因此，基于证据的配置标准对于提高临床护理质量至关重要。其中一种基于证据的方法是使用基于患者病情严重程度的工具。本研究旨在确定一种新生儿病情严重程度工具在澳大利亚三级新生儿保健环境中的表现，重点关注患者病情严重程度分类和护理人员与患者的配置比例，以及与当前实践相比的情况。
在 2023 年的 10 周内，在新生儿重症监护病房（NICU）和特殊护理婴儿病房（SCBU）中收集了病情严重程度数据。在所有入院的新生儿中，在两个时间点（早晨和晚上护理交接班之前），在 16 个领域对患者数据进行评分。
对于接受 1:1 护士与患者配置比例护理的呼吸机支持新生儿，78%的评分处于 L4-高病情严重程度（评分≥26）带，其余评分处于 L3-高病情严重程度（18-25）带。对于在 NICU 接受 1:1 配置比例护理的接受无创呼吸支持的新生儿，在接受鼻高流量通气的新生儿中，评分处于 L4 病情严重程度带的比例高于接受鼻持续气道正压通气的新生儿（P=0.032），而在 NICU 接受 1:2 配置比例护理或在 SCBU 接受鼻高流量通气 1:2 或 1:3 配置比例护理的新生儿中未观察到这种情况。
本研究比较了澳大利亚三级 NICU 中一种新生儿病情严重程度分类系统与当前护士与患者配置比例的情况，表明对于接受呼吸支持的特定患者群体，调整配置比例是可行的。
