성인중환자실 이용 환자의 사망률 관련 요인 분석: 간호등급을 중심으로
Analysis of Factors Related to Mortality in Adult ICU Patients: Focusing on Nurse Staffing Level
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Purpose: The purpose of this study was to assess the influence of nurses staffing level on patient health outcomes inintensive care units (ICUs) in Korea. Methods: The study was retrospective in nature. Information on patients and theiroutcomes, as well as nurse cohort data, were obtained from Korea's National Health Insurance Service Database. Theobservation period was from January 1, 2008 to December 31, 2018, and data for 2,964,991 patients were analyzed. Independent variables included patient' age and sex and hospital type, intensivist, and nurses staffing level. Results: Themortality rate in ICUs was significantly higher at tertiary hospitals with a level 3~4 (HR, 1.21; 95% confidence interval,1.19~1.22) or level 5~9 nurse staffing (HR, 1.31; 95% confidence interval, 1.27~1.34) compare to that of tertiary hospitalswith a 1~2 level. 28-day mortality rate was also higher at general hospitals with a level 3~4 (HR, 1.13; 95% confidenceinterval, 1.12~1.14), level 5~6 (HR. 1.34; 95% confidence interval, 1.32~1.36), level 7~9 nurse staffing (HR, 1.38; 95%confidence interval, 1.38~1.42), using level 1~2 as reference. Conclusion: Nurses staffing level is a key determinant ofhealthcare-associated mortality in critically ICUs patients. Policies to achieve adequate nurse staffing levels are thereforerequired to enhance patient outcomes
Abstract
Purpose: The purpose of this study was to assess the influence of nurses staffing level on patient health outcomes inintensive care units (ICUs) in Korea. Methods: The study was retrospective in nature. Information on patients and theiroutcomes, as well as nurse cohort data, were obtained from Korea's National Health Insurance Service Database. Theobservation period was from January 1, 2008 to December 31, 2018, and data for 2,964,991 patients were analyzed. Independent variables included patient' age and sex and hospital type, intensivist, and nurses staffing level. Results: Themortality rate in ICUs was significantly higher at tertiary hospitals with a level 3~4 (HR, 1.21; 95% confidence interval,1.19~1.22) or level 5~9 nurse staffing (HR, 1.31; 95% confidence interval, 1.27~1.34) compare to that of tertiary hospitalswith a 1~2 level. 28-day mortality rate was also higher at general hospitals with a level 3~4 (HR, 1.13; 95% confidenceinterval, 1.12~1.14), level 5~6 (HR. 1.34; 95% confidence interval, 1.32~1.36), level 7~9 nurse staffing (HR, 1.38; 95%confidence interval, 1.38~1.42), using level 1~2 as reference. Conclusion: Nurses staffing level is a key determinant ofhealthcare-associated mortality in critically ICUs patients. Policies to achieve adequate nurse staffing levels are thereforerequired to enhance patient outcomes
참고문헌 (23)
- Ch, S., "Bed-to-nurse ratios, provision of basic nursing care, and in-hospital and 30-day mortality among acute stroke patients admitted to an intensive care unit : cross-sectional analysis of survey and administrative data", International Journal of Nursing Studies, 46(8), pp.1092~1101 (2009)[DOI]
- 조재화, "중환자실 구성이 2009년 인플루엔자 A", H1N1 중증환자의 사망률에 미친 영향, 2012, pp.27(2), 65~69[DOI]
- Costa, D. K., "The association between daytime Intensivist physician staffing and mortality in the context of other ICU organizational practices : A multicenter cohort study", Critical Care Medicine, 43(11), pp.2275~2282 (2015)[DOI]
- Driscoll, A., "The effect of nurse-to-patient ratios on nursesensitive patient outcomes in acute specialist units : A systematic review and meta-analysis", European Journal of Cardiovascular Nursing, 17(1), pp.6~22 (2018)[DOI]
- Frost, S. A., "Higher nurse staffing levels associated with reductions in unplanned readmissions to intensive care or operating theatre, and in postoperative in-hospital mortality in heart surgery patients", Evidence-Based Nursing, 16(2), pp.62~63 (2013)[DOI]
- Kane, R. L., "The association of registered nurse staffing levels and patient outcomes : Systematic review and meta-analysis", Medical Care, 45(12), pp.1195~1204 (2007)[DOI]
- Kiekkas, P., "Association between nursing workload and mortality of intensive care unit patients", Journal of Nursing Scholarsh, 40(4), pp.385~390 (2008)[DOI]
- Kim, J-H., "Association of nurse staffing grade and 30-day mortality in intensive care units among cardiovascular disease patients", Medicine(Baltimore), 97(42), pp.e12895~ (2018)[DOI]
- Kim, Y., "Association between the bedto-nurse ratio and 30-day post-discharge mortality in patients undergoing surgery : a cross-sectional analysis using Korean administrative data", BMC Nursing, 19, pp.17~ (2020)[DOI]
- Law, A. C., "Patient outcomes after the introduction of statewide ICU nurse staffing regulations", Intensive Care Medicine, 46(10), pp.1563~1569 (2018)[DOI]
- 이병준, "내과계 중환자실 전공의 수와 중환자실 사망률의 관련성", 대한내과학회지, 79(2), pp.155~162 (2010), 대한내과학회
- 이현정, "중환자실에서 간호인력확보수준과 환자 예후와의 상관성", Acute and Critical Care, 28(2), pp.75~79 (2013), 대한중환자의학회
- "Revision of medical care benefits and relative value scale. 2015(2015-2145)"[URL]
- Status of Adult Intensive Care Unit Use by Severity and analysis of medical treatment status by nursing institution, "National Health Insurance Ilsan Hospital Research Institute", ~, pp.Research Report 2020-20-011 (2020)
- Needleman, J., "Nurse-staffing levels and the quality of care in hospitals", New England Journal of Medicine, 346(22), pp.1715~1722 (2002)[DOI]
- Neuraz, A., "Patient mortality is associated with staff resources and workload in the ICU : A Multicenter Observational Study", Critical Care Medicine, 43(8), pp.1587~1594 (2015)
- "OECD health data" (2021)[URL]
- Park, J., "A nationwide analysis of intensive care unit admissions, 2009-2014-The Korean ICU National Data(KIND)study", Journal of Critical Care, 44, pp.24~30 (2018)[DOI]
- The study for improving differentiated inpatient nursing fees by staffing grades, "Shin, Y. S.", Korea Institute for Health and Social Affairs, ~, pp.Report No.: G000CU1-2015-200 (2015)
- Tarnow-Mordi, W. O., "Hospital mortality in relation to staff workload : A 4-year study in an adult intensive-care unit", The Lancet, 356(9225), pp.185~189 (2000)[DOI]
- Tucker, J., "Patient volume, staffing, and workload in relation to risk-adjusted outcomes in a random stratified sample of UK neonatal intensive care units : A prospective evaluation", Lancet, 359(9301), pp.99~107 (2002)[DOI]
- Van den Heede, K., "The relationship between inpatient cardiac surgery mortality and nurse numbers and educational level : Analysis of administrative data", International Journal of Nursing Studies, 46(6), pp.796~803 (2009)[DOI]
- 윤경일, "간호 인력 확보수준 및 구성이 병원 내 사망률에 미치는 영향의 병원 특성별 비교", 보건정보통계학회지, 42(1), pp.27~35 (2017), 한국보건정보통계학회[DOI]
