Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study.
Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study.
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DOI：
10.1016/s0140-6736(13)62631-8
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发表时间：
2014-05-24
期刊：
影响因子：
168.9
通讯作者：
Sermeus, Walter
中科院分区：
文献类型：
--
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
紧缩措施和卫生系统的重新设计，以尽量减少医院支出的风险，对病人的结果产生不利影响。RN 4CAST研究旨在为护理决策提供信息，护理是医院运营费用的最大组成部分之一。我们的目的是评估在12个RN 4CAST国家中有9个具有相似患者出院数据的国家中，患者与护士比率和护士教育资格的差异是否与普通外科手术后医院死亡率的变化相关。在这项观察性研究中，我们获得了9个欧洲国家300家医院422730例50岁或以上接受普通手术的患者的出院数据。管理数据采用标准方案（国际疾病分类第九版或第十版的变体）编码，通过使用风险调整措施（包括年龄、性别、入院类型、提示手术类型的43个虚拟变量和提示入院时存在的合并症的17个虚拟变量）估计30天住院死亡率。26 516名护士在研究医院执业的调查被用来衡量护士的工作人员和护士教育。我们使用广义估计方程来评估护理因素对手术患者在入院后30天内死亡的可能性的影响，在调整其他医院和患者特征之前和之后。护士工作量每增加一名患者，住院患者在入院后30天内死亡的可能性增加7%（比值比1.068，95%CI 1.031 - 1.106），学士学位护士每增加10%，这种可能性降低7%（0.929，0.886 - 0.973）。这些关联意味着，在60%的护士拥有学士学位的医院中，护士平均照顾6名患者的患者的死亡率比只有30%的护士拥有学士学位的医院中的患者低近30%，护士平均照顾8名患者。为了省钱而削减护士人手可能会对病人的预后产生不利影响。加强对护士的学士教育可以减少可预防的医院死亡。欧洲联盟第七个框架方案、国家护理研究所、国家卫生研究所、挪威护士组织和挪威保健服务知识中心、瑞典保健专业人员协会、斯德哥尔摩县理事会和卡罗林斯卡医学院之间关于医疗培训和临床研究的区域协定，卫生和护理科学委员会和护理科学战略研究计划在卡罗林斯卡学院，西班牙科学和创新部。
Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses’ educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. For this observational study, we obtained discharge data for 422 730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26 516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. An increase in a nurses’ workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031–1·106), and every 10% increase in bachelor’s degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886–0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor’s degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor’s degrees and nurses cared for an average of eight patients. Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor’s education for nurses could reduce preventable hospital deaths. European Union’s Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health Professionals, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Committee for Health and Caring Sciences and Strategic Research Program in Care Sciences at Karolinska Institutet, Spanish Ministry of Science and Innovation.