의료기관 간호사 확보수준이 수술환자의 사망, 폐렴, 패혈증, 요로감염에 미치는 영향 = Effects of Hospital Nurse Staffing on in-hospital Mortality, Pneumonia, Sepsis, and Urinary Tract Infection in Surgical Patients

다국어 초록 (Multilingual Abstract)

Purpose: This study was done to examine relationships between nurse staffing level and postsurgical patient outcomes using inpatient database from the National Health Insurance. Methods: Records of 111,491 patients who received one of 12 types of surgery between January and December, 2009 were identified and analyzed in this study. Nurse staffing level was measured using adjusted nurse staffing grades from 0 to 7. Patient outcomes were defined as in-hospital mortality, or pneumonia, sepsis,or urinary tract infection after surgery. Logistic regression analyses estimated by Generalized Estimation Model, were used to analyze the association between nurse staffing level and patient outcomes. Results: An inverse relationship was found between nurse staffing and patient mortality. Compared with patients who were cared for in hospitals with the highest nurse staffing (Grades 0-1), increases in the odds of dying were found in those with Grades 6-7 [OR (odds ratio)=2.99, 95% CI (confidence interval)=1.94-4.60], those with Grades 4-5 (OR=1.78, 95% CI=1.24-2.57) and those with Grades 2-3 (OR=1.57,95% CI=1.25-1.98). Lower nurse staffing level was also associated with higher number of cases in pneumonia and sepsis.
Conclusion: Policies for providing adequate nurse staffing is required to enhance quality of care and lead to better perioperative patient outcomes.

다국어 초록 (Multilingual Abstract)

Purpose: This study was done to examine relationships between nurse staffing level and postsurgical patient outcomes using inpatient database from the National Health Insurance. Methods: Records of 111,491 patients who received one of 12 types of surgery between January and December, 2009 were identified and analyzed in this study. Nurse staffing level was measured using adjusted nurse staffing grades from 0 to 7. Patient outcomes were defined as in-hospital mortality, or pneumonia, sepsis,or urinary tract infection after surgery. Logistic regression analyses estimated by Generalized Estimation Model, were used to analyze the association between nurse staffing level and patient outcomes. Results: An inverse relationship was found between nurse staffing and patient mortality. Compared with patients who were cared for in hospitals with the highest nurse staffing (Grades 0-1), increases in the odds of dying were found in those with Grades 6-7 [OR (odds ratio)=2.99, 95% CI (confidence interval)=1.94-4.60], those with Grades 4-5 (OR=1.78, 95% CI=1.24-2.57) and those with Grades 2-3 (OR=1.57,95% CI=1.25-1.98). Lower nurse staffing level was also associated with higher number of cases in pneumonia and sepsis.
Conclusion: Policies for providing adequate nurse staffing is required to enhance quality of care and lead to better perioperative patient outcomes.

참고문헌 (Reference)

1 김윤미, "종합병원의 일반병동, 중환자실, 응급실, 수술장간호사 확보수준 관련 요인" 간호행정학회 14 (14): 404-412, 2008

2 박성희, "입원환자 간호관리료 차등제에 따른 직접간호활동 및 환자결과 비교" 한국간호과학회 33 (33): 122-129, 2003

3 조성현, "입원환자 간호관리료 차등제 도입이후 간호사 확보수준의 변화" 간호행정학회 14 (14): 167-175, 2008

4 김윤미, "의료기관 특성에 따른 간호등급 변화 추이: 2008~2010년" 병원간호사회 16 (16): 99-109, 2010

5 박옥엽, "간호중재분류체계(NIC)에 근거한 내외과계 간호단위의 간호중재 수행 및 건강보험 수가 항목 분석" 간호행정학회 11 (11): 449-467, 2005

6 Newbold, D., "The production economics of nursing: A discussionpaper" 45 : 120-128, 2008

7 Cho, S. H., "The effects of nurse staffing on adverse events, morbidity, mortality, and medical costs" 52 : 71-79, 2003

8 Kane, R. L., "The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis" 45 : 1195-1204, 2007

9 Ministry of Health and Welfare, "Standard of medical care benefit and resource-based relative value scale of medical procedure"

10 Newhouse, R. P., "Perioperative nurses and patient outcomes-mortality, complications, and length of stay" 81 : 508-528, 2005

11 Rochefort, C. M., "Nurses' work environments, care rationing, job outcomes, and quality of care on neonatal units" 66 : 2213-2224, 2010

12 Needleman, J., "Nurse-staffing in hospital: Is there a business case for quality?" 25 : 204-211, 2006

13 Oman, K. S., "Nurse-directed interventions to reduce catheter-associatedurinary tract infections" 40 : 548-553, 2012

14 Kane, R. L., "Nurse staffing and quality of patient care" Agency for Healthcare Research and Quality 2007

15 Needleman, J., "Nurse staffing and patient outcomes in hospitals" Harvard University 2001

16 van den Heede, K., "Nurse staffing and patient outcomes in Belgian acute hospitals: Cross-sectional analysis of administrative data" 46 : 928-939, 2009

17 김재용, "Nurse staffing and patient mortality in intensive care units" LIPPINCOTT WILLIAMS & WILKINS 57 : 322-330, 200809

18 Cho, S. H., "Nurse staffing and adverse patient outcomes: A systemic approach" 49 : 78-85, 2001

19 Katz, M. H., "Multivariable analysis: A practical guide for clinicians" Cambridge University Press 2006

20 Health Insurance Review & Assessment Service, "KDRG categorization" Health Insurance Review & Assessment Service 2009

21 Sochalski, J., "Is more better? The relationship between nurse staffing and the quality of nursing care in hospitals" 42 (42): II67-II73, 2004

22 van den Heede, K., "International experts' perspectives on the state of the nursestaffing and patient outcomes literature" 39 : 290-297, 2007

23 Aiken, L. H., "Implications of the California nurse staffing mandate for other states" 45 : 904-921, 2010

24 Aiken, L. H., "Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction" 288 : 1987-1993, 2002

25 Halm, M., "Hospital nurse staffing and patient mortality, emotional exhaustion,and job dissatisfaction" 19 (19): 241-251, 2005

26 Kunin, C. M., "Genitourinary infections in the patient at risk: Extrinsic risk factors" 76 : 131-139, 1984

27 Wald, H., "Extended use of indwelling urinary catheters in postoperative hip fracture patients" 43 (43): 1009-1017, 2005

28 Aiken, L. H., "Educational levels of hospital nurses and surgical patient mortality" 290 : 1617-1623, 2003

29 Ranji, S. R., "Closing the quality gap: A critical analysis of quality improvement strategies (Vol. 6: Prevention of healthcare-associated infections)" Agency for Healthcare Research and Quality 2007

30 Korean Standard Statistical Classification, "Classification of disease"