The association between nurse staffing and hospital outcomes in injured patients.
The association between nurse staffing and hospital outcomes in injured patients.
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DOI：
10.1186/1472-6963-12-247
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发表时间：
2012-08-09
影响因子：
2.8
通讯作者：
Stone PW
中科院分区：
文献类型：
--
作者：
Glance LG;Dick AW;Osler TM;Mukamel DB;Li Y;Stone PW
创伤中心面临的巨大财政压力可能会导致创伤中心减少护士人员配备，并增加使用成本较低和技能较低的人员。护士人员配置和技能组合对创伤结局的影响以前没有报道过。本研究的目的是检查护士的人员配备水平和护理技能组合是否与创伤患者的结局相关。我们使用来自医疗保健成本和利用项目全国住院患者样本的数据，对77个I级和II级中心收治的70，142名患者进行了横断面研究。Logistic回归模型用于检查护士配备措施与（1）死亡率，（2）医疗相关感染（HAI）和（3）抢救失败之间的关系。我们控制了患者风险因素（年龄、性别、损伤严重程度、损伤机制、合并症）和医院结构特征（创伤中心状态-I级与II级、医院规模、所有权、教学状况、技术水平和地理区域）。执业护士（LPN）占总护理时间的比例增加1%，死亡率增加4%（adj OR 1.04; 95% CI：1.02-1.06; p = 0.001），败血症发生率增加6%（adj OR 1.06：1.03-1.10; p < 0.001）。与LPN人员配置较低四分位数的医院相比，LPN人员配置最高四分位数的医院每1000例患者中有3例死亡（95% CI：1.2，5.1）和5例败血症发作（95% CI：2.3，7.6）。较高的医院LPN人员配备水平与I级或II级创伤中心收治的创伤患者的死亡率和败血症发生率略高独立相关。
The enormous fiscal pressures facing trauma centers may lead trauma centers to reduce nurse staffing and to make increased use of less expensive and less skilled personnel. The impact of nurse staffing and skill mix on trauma outcomes has not been previously reported. The goal of this study was to examine whether nurse staffing levels and nursing skill mix are associated with trauma patient outcomes. We used data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample to perform a cross-sectional study of 70,142 patients admitted to 77 Level I and Level II centers. Logistic regression models were used to examine the association between nurse staffing measures and (1) mortality, (2) healthcare associated infections (HAI), and (3) failure-to-rescue. We controlled for patient risk factors (age, gender, injury severity, mechanism of injury, comorbidities) and hospital structural characteristics (trauma center status - Level I versus Level II, hospital size, ownership, teaching status, technology level, and geographic region). A 1% increase in the ratio of licensed practical nurse (LPN) to total nursing time was associated with a 4% increase in the odds of mortality (adj OR 1.04; 95% CI: 1.02-1.06; p = 0.001) and a 6% increase in the odds of sepsis (adj OR 1.06: 1.03-1.10; p < 0.001). Hospitals in the highest quartile of LPN staffing had 3 excess deaths (95% CI: 1.2, 5.1) and 5 more episodes of sepsis (95% CI: 2.3, 7.6) per 1000 patients compared to hospitals in the lower quartile of LPN staffing. Higher hospital LPN staffing levels are independently associated with slightly higher rates of mortality and sepsis in trauma patients admitted to Level I or Level II trauma centers.
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影响因子：
11.8
作者：
McDonald, LC;Owings, M;Jernigan, DB
通讯作者：
Jernigan, DB
影响因子：
120.7
作者：
Aiken, LH;Clarke, SP;Silber, JH
通讯作者：
Silber, JH
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
影响因子：
9
作者：
Glance, Laurent G.;Dick, Andrew W.;Mukamel, Dana B.
通讯作者：
Mukamel, Dana B.
影响因子：
9
作者：
Glance, Laurent G.;Dick, Andrew W.;Osler, Turner M.
通讯作者：
Osler, Turner M.