Educational levels of hospital nurses and surgical patient mortality
Educational levels of hospital nurses and surgical patient mortality
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DOI：
10.1001/jama.290.12.1617
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发表时间：
2003-09-24
影响因子：
120.7
通讯作者：
Silber, JH
中科院分区：
文献类型：
--
作者：
Aiken, LH;Clarke, SP;Silber, JH
背景越来越多的证据表明，护士的配备影响了医院的护理质量，目的探讨医院注册护士（RNs）本科以上学历比例与危险调整死亡率和抢救失败率的关系设计、设置和人群对1998年4月1日之间从168家非联邦成人综合宾夕法尼亚医院出院的232342名普通、整形外科和血管外科患者的结果数据进行横断面分析，和1999年11月30日，与提供教育组成，人员配备，主要指标风险调整后的患者死亡率和入院30天内抢救失败与护士教育水平相关。结果医院RN持有学士学位或更高学位的比例范围为0%至77%在医院里。根据患者特征和医院结构特征进行调整后（规模，教学状况，技术水平），以及护士配备，护士经验，以及患者的外科医生是否获得委员会认证，拥有学士学位的护士比例增加10%，降低患者在入院后30天内死亡的可能性和抢救失败的几率结论在护士学历在学士以上的医院，手术患者的死亡率和抢救失败率较低。
Context Growing evidence suggests that nurse staffing affects the quality of care in hospitals, but little is known about whether the educational composition of registered nurses (RNs) in hospitals is related to patient outcomes.Objective To examine whether the proportion of hospital RNs educated at the baccalaureate level or higher is associated with risk-adjusted mortality and failure to rescue (deaths in surgical patients with serious complications).Design, Setting, and Population Cross-sectional analyses of outcomes data for 232342 general, orthopedic, and vascular surgery patients discharged from 168 nonfederal adult general Pennsylvania hospitals between April 1, 1998, and November 30, 1999, linked to administrative and survey data providing information on educational composition, staffing, and other characteristics.Main Outcome Measures Risk-adjusted patient mortality and failure to rescue within 30 days of admission associated with nurse educational level.Results The proportion of hospital RNs holding a bachelor's degree or higher ranged from 0% to 77% across the hospitals. After adjusting for patient characteristics and hospital structural characteristics (size, teaching status, level of technology), as well as for nurse staffing, nurse experience, and whether the patient's surgeon was board certified, a 10% increase in the proportion of nurses holding a bachelor's degree was associated with a 5% decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue (odds ratio, 0.95; 95% confidence interval, 0.91-0.99 in both cases).Conclusion in hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates.