The association between nurse staffing levels and a failure to respond to patients with deranged physiology: A retrospective observational study in the UK
The association between nurse staffing levels and a failure to respond to patients with deranged physiology: A retrospective observational study in the UK
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DOI：
10.1016/j.resuscitation.2020.01.001
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发表时间：
2020-04-01
期刊：
影响因子：
6.5
通讯作者：
Griffiths, Peter
中科院分区：
文献类型：
--
作者：
Smith, Gary B.;Redfern, Oliver;Griffiths, Peter
背景：对病人生命体征异常的反应是护理的一个基本方面。然而，未能对患者病情恶化做出反应是常见的，并且经常导致不良的患者结局。本研究旨在确定注册护士（RN）和护理助理（NA）人员配备水平和未能及时应对患者的异常physiology.Methods：本回顾性观察性研究使用常规收集的患者的生命体征和行政数据，包括护理人员，从32个普通病房的急性医院在英格兰2012年4月至2015年3月之间。混合效应二项回归用于模拟护士配备（以“每患者日小时数”（HPPD）衡量）与代表国家早期预警评分（NEWS）值>= 6和>= 7的患者未能应答的复合主要结局之间的关系。有189，123个NEWS值>= 6，114，504个NEWS值>= 7，影响28，098名患者。对于NEWS值>= 7的患者，应答失败与RN HPPD水平显著相关（IRR 0.98，95%CI 0.96-0.99，p = 0.0001），但与NA HPPD水平无关（IRR 0.99，95%CI 0.96 - 1.01，p = 0.238）。对于NEWS值>= 6的患者，没有这样的关系existing.Conclusions：RN，但不NA，人员配备水平影响失败率响应最异常的生命体征（NEWS值>= 7）的患者。这些发现为越来越多的报道提供了一种可能的解释，即低RN人员配置与住院期间患者死亡风险增加之间存在相关性。
Background: Responding to abnormalities in patients' vital signs is a fundamental aspect of nursing. However, failure to respond to patient deterioration is common and often leads to adverse patient outcomes. This study aimed to determine the association between Registered Nurse (RN) and Nursing Assistant (NA) staffing levels and the failure to respond promptly to patients' abnormal physiology.Methods: This retrospective, observational study used routinely collected patients' vital signs and administrative data, including nursing staffing, from 32 general wards of an acute hospital in England between April 2012 and March 2015. Mixed-effects binomial regression was used to model the relationship between nurse staffing, measured as 'Hours per Patient Day' (HPPD), and a composite primary outcome representing failure to respond for patients with National Early Warning Score (NEWS) values >= 6 and >= 7.Results: There were 189,123 NEWS values >= 6 and 114,504 NEWS values >= 7, affecting 28,098 patients. For patients with NEWS values >= 7, failure to respond was significantly associated with levels of RN HPPD ((IRR 0.98, 95% CI 0.96-0.99, p = 0.0001) but not NA HPPD (((IRR 0.99, 95%CI 0.96 -1.01, p = 0.238). For patients with NEWS values >= 6, no such relationship existed.Conclusions: RN, but not NA, staffing levels influence the rates of failure to respond for patients with the most abnormal vital signs (NEWS values >= 7). These findings offer a possible explanation for the increasingly reported association between low RN staffing and an increased risk of patient death during a hospital admission.