NICU Performance: Missed Nursing Care and Infant Outcomes

新生儿重症监护室表现：漏诊和婴儿结局 在美国，每年超过一半的婴儿死亡是由极低出生率的婴儿造成的。 重量（VLBW）（< 1500克或3.3磅），表明60，000多人的高死亡率负担 出生时患有VLBW的婴儿。四分之一的极低出生体重婴儿死亡;十分之九的死亡发生在第一个月 在新生儿重症监护室（NICU）住院期间，有大量无法解释的变化， 新生儿重症监护病房的极低出生体重婴儿死亡率不能用婴儿风险因素来解释，这提供了一个令人信服的 我们需要检查医疗保健系统中导致这些变化的因素。由于最佳 VLBW婴儿的管理依赖于熟练的护理，NICU护士平均照顾2或3个 婴儿在同一时间，我们试图确定是否错过护理帐户的变化，婴儿死亡率， 医院感染，住院时间和父母满意度，以确定干预点， 改善成果。遗漏护理，定义为遗漏或延迟的所需护理， 对多重需求或资源不足的反应，在这种情况下发生， 对患者结局的影响。因此，迫切需要量化对婴儿的影响， 父母，并确定因素负责错过护理。这项研究的结果将允许 开发新的，基于证据的，临床有效的策略，以改善健康和生活 极低出生体重儿的病程。确定错过护理对婴儿结局和父母满意度的影响 为了确定与错过NICU护理相关的因素，我们将首先合并四个大数据集：1） 国家护理质量指标数据库注册护士调查（NDNQI RN调查）， 包括失访护理、护士工作环境、NICU护士适应能力等 工作负载，2）医疗成本和效用项目状态住院患者数据，提供患者数据 结果，3）美国医院协会关于医院结构措施的数据，以及4）医疗保险 成本报告，提供财务利润数据。然后，我们将通过一个 在与NDNQI RN调查数据相关的24个NDNQI单位调查了240名极低出生体重婴儿的父母。数据来自89 全国的NICU（代表5，785名VLBW婴儿），我们将能够（目标1）： 极低出生体重儿的护理缺失与新生儿重症监护病房患者预后之间的关系。通过主要家长调查 数据，我们将能够（目标2）：确定错过护理和父母满意度之间的关联 在NICU护理;并从179个NICU雇用的8，950名RN的数据能够（目标3）：识别护士 NICU组织因素与漏诊护理相关。这项研究将导致更健康的 通过改善护理，为在NICU接受治疗的高危婴儿提供更好的生活和更好的父母体验。

NICU PERFORMANCE: MISSED NURSING CARE AND INFANT OUTCOMES   More than half of all infant deaths annually in the U.S. are accounted for by infants with very low birth weight (VLBW)(< 1500 grams or 3.3 lbs.), indicating the high mortality burden carried by the over 60,000 infants born with VLBW. One in four VLBW infants dies; nine out of ten of these deaths occur in the first month of life while hospitalized in the neonatal intensive care unit (NICU). There are large unexplained variations in VLBW infant mortality across NICUs that cannot be accounted for by infant risk factors, providing a compelling need to examine factors in the health care system that account for these variations. Since optimal management of VLBW infants depends on skilled nursing care, with the average NICU nurse caring for 2 or 3 infants at a time, we seek to ascertain if missed nursing care accounts for variation in infant mortality, nosocomial infection, length of stay, and parental satisfaction in order to identify points of intervention to improve outcomes. Missed nursing care, defined as required nursing care that is omitted or delayed in response to multiple demands or inadequate resources, occurs in this setting with potentially important consequences on patient outcomes. Therefore there is a critical need to quantify the impact on infants and parents and to identify the factors responsible for missed nursing care. The results of this study will allow for the development of novel, evidence-based, and clinically effective strategies to improve the health and life course of VLBW infants. To determine the effects of missed care on infant outcomes and parent satisfaction and to determine factors associated with missed NICU nursing care, we will first merge four large datasets: 1) the National Database of Nursing Quality Indicators Registered Nurse Survey (NDNQI RN Survey) which includes information on missed care nursing, the nurse work environment and acuity-adjusted NICU nurse workload, 2) the Healthcare Cost and Utility Project State Inpatient Data that provides data on patient outcomes, 3) the American Hospital Association data on hospital structural measures, and 4) the Medicare Cost Report, which provides data on financial margins. Then, we will study parental satisfaction through a survey 240 parents of VLBW infants in 24 NDNQI units linked to the NDNQI RN survey data. With data from 89 NICUs across the nation (representing 5,785 VLBW infants) we will be able to (Aim 1): Determine associations between missed nursing care and NICU patient outcomes for VLBW infants. With the primary parent survey data we will be able to (Aim 2): Determine the association between missed nursing care and parent satisfaction with care in the NICU; and with data from 8,950 RNs employed in 179 NICUs be able to (Aim 3): Identify nurse and NICU organizational factors associated with missed nursing care. This research will result in healthier lives and better parental experiences for high-risk infants treated in the NICU by improving nursing care.