NICU Performance: Missed Nursing Care and Infant Outcomes

NICU表现：错过护理与婴儿结局 -- 在美国，每年有超过一半的婴儿死亡是由出生极低的婴儿造成的 体重(VLBW)(&lt；1500克或3.3磅)，表明60,000以上的人承受着很高的死亡负担 出生时患有极低出生体重的婴儿。1/4的极低出生体重婴儿死亡；其中9/10的死亡发生在出生后的第一个月 在新生儿重症监护病房(NICU)住院期间的生命危险。有大量无法解释的变化 NICU中无法用婴儿风险因素解释的VLBW婴儿死亡率，提供了一个令人信服的 需要检查卫生保健系统中解释这些差异的因素。自最优以来 对极低出生体重儿的管理依赖于熟练的护理，平均每个NICU护士照顾2到3个 每次都是婴儿，我们试图确定错过护理是否导致婴儿死亡率的差异， 医院感染、住院时间和父母满意度，以确定干预点 改善结果。遗漏护理，定义为遗漏或延误的所需护理 对多个需求或资源不足的响应，在这种情况下发生，具有潜在的重要 对患者结局的影响。因此，迫切需要量化对婴儿和 并找出造成遗漏护理的因素。这项研究的结果将允许 开发新的、循证的和临床有效的策略来改善健康和生活 极低出生体重儿的病程。确定遗漏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型数据集：1) 全国护理质量指标数据库注册护士调查(NDNQI RN Survey) 包括遗漏护理、护士工作环境和调整视力的NICU护士的信息 工作负载，2)提供患者数据的医疗保健成本和公用事业项目状态住院数据 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，提供财务利润率数据。然后，我们将通过一个 在与NDNQI RN调查数据相关联的24个NDNQI单位对240名极低出生体重儿的父母进行调查。使用来自89的数据 全国的NICU(代表5785名极低出生体重儿)我们将能够(目标1)：确定关联 极低出生体重儿护理缺失与NICU患者结局之间的关系。与主要家长调查 我们将能够(目标2)的数据：确定错过护理与父母满意度之间的关联 通过NICU的护理；以及179个NICU雇用的8950个RN的数据，能够(目标3)：识别护士 以及与错过护理有关的NICU组织因素。这项研究将带来更健康的结果 通过改善护理，改善在NICU治疗的高危婴儿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.