Patient outcomes when hospitals experience a surge in admissions
Patient outcomes when hospitals experience a surge in admissions
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DOI：
10.1016/j.jhealeco.2005.10.003
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发表时间：
2006-03-01
影响因子：
3.5
通讯作者：
Kim, B
中科院分区：
文献类型：
--
作者：
Evans, WN;Kim, B
2004年1月，1999年通过的一项加州法律生效，规定了医院单位的最低护士与病人比例。这项立法是由以前的研究结果所推动的，这些研究表明，当医院护士/病人比例较低时，病人的不良后果更高。在这项研究中，我们使用了一个在加州在1996年至2000年期间的医院出院人口普查，以估计医院的工作人员水平对不良事件的影响，通过检查结果是否与在未来2天的入院人数相关。由于医院的工作人员水平是事先确定的，因此在接下来的2天内，大量患者涌入医院将减少先前入院患者的有效工作人员水平。我们把重点放在星期四入院病人的结果上，因为星期五和星期六入院病人的情况变化最大，医院的工作人员也是如此。周末最低。我们发现一些证据表明，星期五和星期六对入院的巨大冲击往往会减少住院时间并增加随后再次入院的机会，但这些系数非常小。我们发现周五和周六入院休克对周四入院患者的死亡率的影响在数量上很小，统计学上不显著。这些结果表明，加州法律的一部分，旨在保证足够的人员配备时，病人的人口普查意外增加应该对病人的结果影响不大。(c)2005 Elsevier B. V.保留所有权利。
In January 2004, a California law passed in 1999 became effective regulating minimum nurse to patient ratios in hospital units. This legislation was prompted by results from previous research showing higher adverse patient outcomes when hospital nurse/patient ratios are low. In this study, we use a census of hospital discharges in California over the 1996-2000 period to estimate the impact of hospital staff levels on adverse events by examining whether outcomes are correlated with the number of admissions in the hospital over the next 2 days. Because hospital staff levels are determined in advance, a large influx of patients to a hospital over the next 2 days will reduce the effective staff levels for patients admitted previously. We focus on the Outcomes of patients admitted on Thursdays because hospital admissions are the most variable on Friday and Saturday and hospital staff,.; are lowest during the weekend. We find some evidence that large shocks to admissions on Friday and Saturday tend to reduce the length of stay and increase the chance of a subsequent readmission, but these coefficients are very small. We find quantitatively small and statistically insignificant effects of Friday and Saturday admission shocks on mortality rates of patients admitted on Thursdays. These results Suggest that the portion of the California law designed to guarantee adequate staffing when the patient census increases unexpectedly should have little impact on patient outcomes. (c) 2005 Elsevier B.V. All rights reserved.