护理复杂性增加会提高儿童院内及重症监护病房转院风险吗？一项回顾性观察研究。

Can an increase in nursing care complexity raise the risk of intra-hospital and intensive care unit transfers in children? A retrospective observational study.

作者信息

Cesare Manuele, Cocchieri Antonello

机构信息

Gemelli IRCCS University Hospital Foundation, Largo Agostino Gemelli 8, 00168, Rome, Italy.

Section of Hygiene, Woman and Child Health and Public Health, Gemelli IRCCS University Hospital Foundation, Largo Agostino Gemelli 8, 00168 Rome, Italy; Section of Hygiene, University Department of Life Sciences and Public Health, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy.

出版信息

J Pediatr Nurs. 2025 Jan-Feb;80:91-99. doi: 10.1016/j.pedn.2024.11.015. Epub 2024 Nov 26.

DOI:10.1016/j.pedn.2024.11.015

PMID:39602875

Abstract

INTRODUCTION

Intra-hospital patient transfers (IPTs) and transfers to intensive care units (ICUs) are high-risk events in pediatric care. Nursing care complexity, reflected by nursing diagnoses (NDs) and nursing actions (NAs), may influence the frequency of these transfers. This study explores the association between nursing care complexity and IPTs, including ICU transfers, in hospitalized children.

MATERIALS AND METHODS

A retrospective observational study was conducted at a tertiary care university hospital in Italy. Data from 1013 children aged 2 to 12 years were collected from electronic health records. Sociodemographic, clinical, and nursing data, including NDs and NAs, were analyzed. Latent Class Analysis classified nursing care complexity, while backward elimination regression and binary logistic regression identified predictors of IPTs and ICU transfers.

RESULTS

Significant positive correlations were found between IPTs and both NDs (r = 0.326, p < 0.001) and NAs (r = 0.428, p < 0.001). Key predictors of IPTs included Diagnosis Related Groups (DRG) weight, total comorbidities, surgical DRG, the number of medications used, and high nursing care complexity. ICU-transferred patients had significantly higher nursing care complexity (6.54 vs. 3.46 NDs, p < 0.001; 31 vs. 16 NAs, p < 0.001). High nursing care complexity increased the likelihood of ICU transfer by 18 times (OR = 18.413, p < 0.001).

CONCLUSION

Nursing care complexity strongly influences IPTs and ICU transfers. Close monitoring of patients with high nursing care complexity is essential to anticipate transfers and reduce clinical risks.

摘要

引言

医院内患者转运（IPTs）以及转至重症监护病房（ICUs）是儿科护理中的高风险事件。由护理诊断（NDs）和护理措施（NAs）所反映的护理复杂性可能会影响此类转运的频率。本研究探讨住院儿童护理复杂性与IPTs（包括转至ICU）之间的关联。

材料与方法

在意大利一家三级护理大学医院进行了一项回顾性观察研究。从电子健康记录中收集了1013名2至12岁儿童的数据。对社会人口统计学、临床和护理数据（包括NDs和NAs）进行了分析。潜在类别分析对护理复杂性进行了分类，而向后剔除法回归和二元逻辑回归确定了IPTs和转至ICU的预测因素。

结果

IPTs与NDs（r = 0.326，p < 0.001）和NAs（r = 0.428，p < 0.001）之间均存在显著正相关。IPTs的关键预测因素包括诊断相关组（DRG）权重、共病总数、手术DRG、用药数量以及高护理复杂性。转至ICU的患者护理复杂性显著更高（NDs分别为6.54对3.46，p < 0.001；NAs分别为31对16，p < 0.001）。高护理复杂性使转至ICU的可能性增加了18倍（OR = 18.413，p < 0.001）。