The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: a cross-sectional study of US hospitals.
The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: a cross-sectional study of US hospitals.
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DOI：
10.1136/bmjqs-2014-003346
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发表时间：
2015-04
影响因子：
5.4
通讯作者：
Kutney-Lee A
中科院分区：
文献类型：
--
作者：
Carthon JM;Lasater KB;Sloane DM;Kutney-Lee A
当忽略必要的护理时，可能存在对质量和患者安全的威胁。需要进行实证研究，以确定错过护理是如何与病人的结果。本研究旨在探讨护理缺失与再入院之相关性。横断面研究，使用三个相关的数据来源-（1）护士调查，（2）来自三个州（加州，新泽西和宾夕法尼亚）的患者出院数据和（3）行政医院数据-从2005年到2006年。我们探讨了美国419家急诊医院160930例心力衰竭患者30天再入院的发生率。Logistic回归分析用于评估错过护理对再入院几率的影响，调整患者和医院特征。在我们的样本中，所有医院最常错过的护理活动包括与患者交谈和安慰（42.0%），制定和更新护理计划（35.8%）以及教育患者和家属（31.5%）。对于10项研究的护理活动中的4项，在调整患者和医院特征后，报告错过活动的护士人数每增加10个百分点，再入院几率增加2-8%。然而，一旦调整护士工作环境，错过护理不再是再入院的重要预测因素，除了治疗和程序的交付（OR 1.08，95% CI 1.02至1.14）。漏诊是心力衰竭再入院的独立预测因素。然而，一旦调整护士工作环境的质量，这种关系就减弱了。改善护士的工作条件可能是减少护理疏忽和改善患者预后的一种策略。
Threats to quality and patient safety may exist when necessary nursing care is omitted. Empirical research is needed to determine how missed nursing care is associated with patient outcomes. The aim of this study was to examine the relationship between missed nursing care and hospital readmissions. Cross-sectional examination, using three linked data sources—(1) nurse survey, (2) patient discharge data from three states (California, New Jersey and Pennsylvania) and (3) administrative hospital data— from 2005 to 2006. We explored the incidence of 30-day readmission for 160 930 patients with heart failure in 419 acute care hospitals in the USA. Logistic regression was used to assess the effect of missed care on the odds of readmission, adjusting for patient and hospital characteristics. The most frequently missed nursing care activities across all hospitals in our sample included talking to and comforting patients (42.0%), developing and updating care plans (35.8%) and educating patients and families (31.5%). For 4 of the 10 studied care activities, each 10 percentage-point increase in the number of nurses reporting having missed the activity was associated with an increase in the odds of readmission by 2–8% after adjusting for patient and hospital characteristics. However, missed nursing care was no longer a significant predictor of readmission once adjusting for the nurse work environment, except in the case of the delivery of treatments and procedures (OR 1.08, 95% CI 1.02 to 1.14). Missed care is an independent predictor of heart failure readmissions. However, once adjusting for the quality of the nurse work environment, this relationship is attenuated. Improvements in nurses’ working conditions may be one strategy to reduce care omissions and improve patient outcomes.
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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：
8.1
作者：
Kirwan, Marcia;Matthews, Anne;Scott, P. Anne
通讯作者：
Scott, P. Anne
影响因子：
12.7
作者：
Chin, MH;Goldman, L
通讯作者：
Goldman, L
影响因子：
--
作者：
GHALI, JK;KADAKIA, S;FERLINZ, J
通讯作者：
FERLINZ, J
影响因子：
3.8
作者：
Kalisch, Beatrice J.;Landstrom, Gay L.;Hinshaw, Ada Sue
通讯作者：
Hinshaw, Ada Sue