Nurse staffing and inpatient mortality in the English National Health Service: a retrospective longitudinal study.
Nurse staffing and inpatient mortality in the English National Health Service: a retrospective longitudinal study.
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DOI：
10.1136/bmjqs-2022-015291
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发表时间：
2023-05
影响因子：
5.4
通讯作者：
Propper, Carol
中科院分区：
文献类型：
--
作者：
Zaranko, Ben;Sanford, Natalie Jean;Kelly, Elaine;Rafferty, Anne Marie;Bird, James;Mercuri, Luca;Sigsworth, Janice;Wells, Mary;Propper, Carol
探讨护理团队规模及组成对住院病人死亡率的影响。一项回顾性纵向研究，使用关联的护理人员花名册和患者数据。多水平条件Logistic回归模型，调整患者的特征，天和时间不变的病房差异估计住院死亡率和人员配置之间的关联在病房天的水平。构建了两个人员配置措施：目标工作时数的比例（填补率）和目标时数的绝对差异。在英国，一个国家卫生服务信托基金会内有三家医院。19287个病房日观察结果，包括2017日历年53个急性成人患者住院病房的4498名护士和66923名住院患者的信息。住院死亡。注册护士（RN）的填补率和住院死亡率之间的统计学显着相关性（OR 0.9883，95%CI 0.9773至0.9996，p=0.0416），发现只有RN的医院雇员。没有医疗保健支持工作者（HCSW）或机构工作人员的协会。平均而言，RN额外12小时轮班与患者死亡几率降低9.6%相关（OR 0.9044，95% CI 0.8219至0.9966，p=0.0416）。额外的高级RN（在NHS工资等级7或8）的影响是额外的等级5 RN的2.2倍（等级7和8的填充率：OR 0.9760，95% CI 0.9551至0.9973，p=0.0275;等级5：OR 0.9893，95% CI 0.9771至1.0017，p=0.0907）。RN人员配备和资历水平与患者死亡率相关。HCSW和机构护士缺乏联系表明，他们不能有效地替代经常在病房工作的RN。
To examine the impact of nursing team size and composition on inpatient hospital mortality. A retrospective longitudinal study using linked nursing staff rostering and patient data. Multilevel conditional logistic regression models with adjustment for patient characteristics, day and time-invariant ward differences estimated the association between inpatient mortality and staffing at the ward-day level. Two staffing measures were constructed: the fraction of target hours worked (fill-rate) and the absolute difference from target hours. Three hospitals within a single National Health Service Trust in England. 19 287 ward-day observations with information on 4498 nurses and 66 923 hospital admissions in 53 inpatient hospital wards for acutely ill adult patients for calendar year 2017. In-hospital deaths. A statistically significant association between the fill-rate for registered nurses (RNs) and inpatient mortality (OR 0.9883, 95% CI 0.9773 to 0.9996, p=0.0416) was found only for RNs hospital employees. There was no association for healthcare support workers (HCSWs) or agency workers. On average, an extra 12-hour shift by an RN was associated with a reduction in the odds of a patient death of 9.6% (OR 0.9044, 95% CI 0.8219 to 0.9966, p=0.0416). An additional senior RN (in NHS pay band 7 or 8) had 2.2 times the impact of an additional band 5 RN (fill-rate for bands 7 and 8: OR 0.9760, 95% CI 0.9551 to 0.9973, p=0.0275; band 5: OR 0.9893, 95% CI 0.9771 to 1.0017, p=0.0907). RN staffing and seniority levels were associated with patient mortality. The lack of association for HCSWs and agency nurses indicates they are not effective substitutes for RNs who regularly work on the ward.
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影响因子：
168.9
作者：
Aiken, Linda H.;Sloane, Douglas M.;Bruyneel, Luk;Van den Heede, Koen;Griffiths, Peter;Busse, Reinhard;Diomidous, Marianna;Kinnunen, Juha;Kozka, Maria;Lesaffre, Emmanuel;McHugh, Matthew D.;Moreno-Casbas, M. T.;Rafferty, Anne Marie;Schwendimann, Rene;Scott, P. Anne;Tishelman, Carol;van Achterberg, Theo;Sermeus, Walter
通讯作者：
Sermeus, Walter
影响因子：
6.5
作者：
Smith, Gary B.;Redfern, Oliver;Griffiths, Peter
通讯作者：
Griffiths, Peter
影响因子：
5.4
作者：
Huckman, RS;Pisano, GP
通讯作者：
Pisano, GP
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
影响因子：
5.5
作者：
Sheward, Louisa;Hunt, Jennifer;Ball, Jane
通讯作者：
Ball, Jane