Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States.
Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States.
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DOI：
10.1136/bmj.e1717
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发表时间：
2012-03-20
期刊：
影响因子：
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通讯作者：
Kutney-Lee A
中科院分区：
文献类型：
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作者：
Aiken LH;Sermeus W;Van den Heede K;Sloane DM;Busse R;McKee M;Bruyneel L;Rafferty AM;Griffiths P;Moreno-Casbas MT;Tishelman C;Scott A;Brzostek T;Kinnunen J;Schwendimann R;Heinen M;Zikos D;Sjetne IS;Smith HL;Kutney-Lee A
目的 确定拥有良好护理组织（例如改善护士人员配置和工作环境）的医院是否会影响欧洲国家的患者护理和护士队伍稳定性。设计患者和护士的横断面调查。环境 对普通急症护理医院的护士进行了调查（12 个欧洲国家有 488 名护士；美国有 617 名护士）； 210 家欧洲医院和 430 家美国医院的患者接受了调查。欧洲参与者 33 659 名护士和 11 318 名患者；美国有 27509 名护士和超过 120000 名患者。主要结果衡量护士结果（医院人员配置、工作环境、倦怠、不满意、明年离职的意愿、患者安全、护理质量）、患者结果（总体满意度和护理护理、推荐医院的意愿）。结果 报告患者护理质量较差或一般的护士比例因国家/地区差异很大（从 11%（爱尔兰）到 47%（希腊）），给医院安全评级较差或不及格的护士比例也有很大差异（4%（瑞士）到 18%（波兰））。我们发现，护士倦怠率很高（10%（荷兰）到 78%（希腊）），工作满意度很高（11%（荷兰）到 56%（希腊）），离职意愿很高（14%（美国）到 49%（芬兰、希腊））。患者对医院的高评价也存在很大差异（35%（西班牙）至 61%（芬兰、爱尔兰）），患者愿意推荐其医院的比例也有很大差异（53%（希腊）至 78%（瑞士））。工作环境的改善和患者与护士比例的降低与护理质量和患者满意度的提高相关。在欧洲医院，根据医院和护士特征进行调整后，工作环境较好的护士报告护理质量较差或一般的可能性（调整后的比值比为 0.56，95% 置信区间为 0.51 至 0.61）并给医院的患者安全评分为较差或不及格（0.50、0.44 至 0.56）。每位护士每增加一名患者，护士报告护理质量较差或一般（1.11、1.07 至 1.15）以及安全等级较差或不及格（1.10、1.05 至 1.16）的几率就会增加。工作环境较好的医院的患者更有可能对他们的医院给予高评价（1.16、1.03至1.32）并推荐他们的医院（1.20、1.05至1.37），而患者与护士比例较高的医院则不太可能对他们的医院给予高评价（0.94、0.91至0.97）或推荐他们的医院（0.95、0.91至0.98）。美国的结果类似。护士和患者就哪些医院提供良好的护理和可以推荐达成一致。结论 医院护理质量缺陷在所有国家都很常见。改善医院工作环境可能是提高医院护理安全和质量并提高患者满意度的相对低成本策略。
Objective To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. Design Cross sectional surveys of patients and nurses. Setting Nurses were surveyed in general acute care hospitals (488 in 12 European countries; 617 in the United States); patients were surveyed in 210 European hospitals and 430 US hospitals. Participants 33 659 nurses and 11 318 patients in Europe; 27 509 nurses and more than 120 000 patients in the US. Main outcome measures Nurse outcomes (hospital staffing, work environments, burnout, dissatisfaction, intention to leave job in the next year, patient safety, quality of care), patient outcomes (satisfaction overall and with nursing care, willingness to recommend hospitals). Results The percentage of nurses reporting poor or fair quality of patient care varied substantially by country (from 11% (Ireland) to 47% (Greece)), as did rates for nurses who gave their hospital a poor or failing safety grade (4% (Switzerland) to 18% (Poland)). We found high rates of nurse burnout (10% (Netherlands) to 78% (Greece)), job dissatisfaction (11% (Netherlands) to 56% (Greece)), and intention to leave (14% (US) to 49% (Finland, Greece)). Patients’ high ratings of their hospitals also varied considerably (35% (Spain) to 61% (Finland, Ireland)), as did rates of patients willing to recommend their hospital (53% (Greece) to 78% (Switzerland)). Improved work environments and reduced ratios of patients to nurses were associated with increased care quality and patient satisfaction. In European hospitals, after adjusting for hospital and nurse characteristics, nurses with better work environments were half as likely to report poor or fair care quality (adjusted odds ratio 0.56, 95% confidence interval 0.51 to 0.61) and give their hospitals poor or failing grades on patient safety (0.50, 0.44 to 0.56). Each additional patient per nurse increased the odds of nurses reporting poor or fair quality care (1.11, 1.07 to 1.15) and poor or failing safety grades (1.10, 1.05 to 1.16). Patients in hospitals with better work environments were more likely to rate their hospital highly (1.16, 1.03 to 1.32) and recommend their hospitals (1.20, 1.05 to 1.37), whereas those with higher ratios of patients to nurses were less likely to rate them highly (0.94, 0.91 to 0.97) or recommend them (0.95, 0.91 to 0.98). Results were similar in the US. Nurses and patients agreed on which hospitals provided good care and could be recommended. Conclusions Deficits in hospital care quality were common in all countries. Improvement of hospital work environments might be a relatively low cost strategy to improve safety and quality in hospital care and to increase patient satisfaction.