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      중환자실 간호사 배치수준과 중증 간호행위의 관련성 : 2009∼2020년 건강보험 청구자료 분석 = Relationship between Nurse Staffing and Critical Nursing Activities in Intensive Care Units : Analysis of National Health Insurance Claims Data from 2009 to 2020

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      https://www.riss.kr/link?id=A109118449

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      Purpose : This study aimed to investigate changes in critical nursing activities from 2009 to 2020 and explore the relationship between nurse staffing and such activities in intensive care units.Methods : A total of 446,445 adult patients admitted to intensive care units in tertiary and general hospitals from 2009 to 2020 were identified using the National Health Insurance claims database. The Critical Nursing Activities Index was calculated based on the following critical nursing activities: ventilator, extracorporeal membrane oxygenation (ECMO), and continuous renal replacement therapy (CRRT). Trend analysis was performed to analyze changes in critical nursing activities over 12 years and to assess linear trends across different staffing levels.Results : The annual utilization days for ventilators, ECMO, and CRRT, as well as the Critical Nursing Activities Index significantly increased over the study period (<i>p</i>-for-trend<.001) in tertiary and general hospitals, except for ventilator use in general hospitals. Ventilator, ECMO, and CRRT utilization exhibited a significant upward trend with higher nurse staffing levels (Bonferroni adjusted <i>p</i>-for-trend<.001). The Critical Nursing Activities Index was significantly higher in hospitals with higher staffing levels compared to those with lower staffing levels (Bonferroni adjusted <i>p</i> <.05).Conclusion : The findings underscore the need for improved nurse staffing levels in intensive care units. Government policies should ensure that staffing levels align with critical nursing activities among critically ill patients to uphold the quality of care.
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      Purpose : This study aimed to investigate changes in critical nursing activities from 2009 to 2020 and explore the relationship between nurse staffing and such activities in intensive care units.Methods : A total of 446,445 adult patients admitted to ...

      Purpose : This study aimed to investigate changes in critical nursing activities from 2009 to 2020 and explore the relationship between nurse staffing and such activities in intensive care units.Methods : A total of 446,445 adult patients admitted to intensive care units in tertiary and general hospitals from 2009 to 2020 were identified using the National Health Insurance claims database. The Critical Nursing Activities Index was calculated based on the following critical nursing activities: ventilator, extracorporeal membrane oxygenation (ECMO), and continuous renal replacement therapy (CRRT). Trend analysis was performed to analyze changes in critical nursing activities over 12 years and to assess linear trends across different staffing levels.Results : The annual utilization days for ventilators, ECMO, and CRRT, as well as the Critical Nursing Activities Index significantly increased over the study period (<i>p</i>-for-trend<.001) in tertiary and general hospitals, except for ventilator use in general hospitals. Ventilator, ECMO, and CRRT utilization exhibited a significant upward trend with higher nurse staffing levels (Bonferroni adjusted <i>p</i>-for-trend<.001). The Critical Nursing Activities Index was significantly higher in hospitals with higher staffing levels compared to those with lower staffing levels (Bonferroni adjusted <i>p</i> <.05).Conclusion : The findings underscore the need for improved nurse staffing levels in intensive care units. Government policies should ensure that staffing levels align with critical nursing activities among critically ill patients to uphold the quality of care.

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      참고문헌 (Reference)

      1 김진영 ; 홍상범, "Treatment of acute respiratory failure : extracorporeal membrane oxygenation" 65 (65): 157-166, 2022

      2 조성현 ; 이지윤 ; 홍경진 ; 허익수, "The relationship between average length of stay and nurse staffing in general hospitals from 1996 to 2016" 26 (26): 521-532, 2020

      3 Lucchini A, "The evaluation of nursing workload within an Italian ECMO centre : a retrospective observational study" 55 : 102749-, 2019

      4 Jung M, "The effect of bed-to-nurse ratio on hospital mortality of critically ill children on mechanical ventilation : A nationwide population-based study" 10 : 1-8, 2020

      5 Chatfield M, "The Skillings-Mack test(Friedman test when there are missing data)" 9 (9): 299-305, 2009

      6 Lee JM, "Status of adult intensive care unit utilization by severity of illness and medical treatment by institution" National Health Insurance Service Ilsan Hospital Research Institute 2021

      7 Ministry of Health and Welfare (KR), "Revision of the notification of the application standards and methods of medical care benefits (Notice No. 2019-113)" Ministry of Health and Welfare

      8 Health Insurance Review & Assessment Service(KR), "Revision of the notification of the application standards and methods for medical care benefits (Notice No. 2020-186)" Health Insurance Review & Assessment Service

      9 Health Insurance Review & Assessment Service (KR), "Revision of the notice No. 2023-187" Health Insurance Review & Assessment Service

      10 고우리 ; 조성현, "Relationship between patient classification system and APACHE II scores, and mortality prediction in a surgical intensive care unit" 30 (30): 67-78, 2024

      1 김진영 ; 홍상범, "Treatment of acute respiratory failure : extracorporeal membrane oxygenation" 65 (65): 157-166, 2022

      2 조성현 ; 이지윤 ; 홍경진 ; 허익수, "The relationship between average length of stay and nurse staffing in general hospitals from 1996 to 2016" 26 (26): 521-532, 2020

      3 Lucchini A, "The evaluation of nursing workload within an Italian ECMO centre : a retrospective observational study" 55 : 102749-, 2019

      4 Jung M, "The effect of bed-to-nurse ratio on hospital mortality of critically ill children on mechanical ventilation : A nationwide population-based study" 10 : 1-8, 2020

      5 Chatfield M, "The Skillings-Mack test(Friedman test when there are missing data)" 9 (9): 299-305, 2009

      6 Lee JM, "Status of adult intensive care unit utilization by severity of illness and medical treatment by institution" National Health Insurance Service Ilsan Hospital Research Institute 2021

      7 Ministry of Health and Welfare (KR), "Revision of the notification of the application standards and methods of medical care benefits (Notice No. 2019-113)" Ministry of Health and Welfare

      8 Health Insurance Review & Assessment Service(KR), "Revision of the notification of the application standards and methods for medical care benefits (Notice No. 2020-186)" Health Insurance Review & Assessment Service

      9 Health Insurance Review & Assessment Service (KR), "Revision of the notice No. 2023-187" Health Insurance Review & Assessment Service

      10 고우리 ; 조성현, "Relationship between patient classification system and APACHE II scores, and mortality prediction in a surgical intensive care unit" 30 (30): 67-78, 2024

      11 Ministry of Health and Welfare (KR), "Press release:From July 1, hospitalization cost will be halved, with insurance coverage for 2-3 bed rooms in tertiary and general hospitals" Ministry of Health and Welfare

      12 Ministry of Health and Welfare (KR), "Press release:COVID-19 domestic outbreak status (regular briefing)" Ministry of Health and Welfare

      13 Hughes RG, "Patient safety and quality: An evidence-based handbook for nurses" Agency for Healthcare Research and Quality 2008

      14 Rae PJL, "Outcomes sensitive to critical care nurse staffing levels : A systematic review" 67 : 103110-, 2021

      15 Yun S, "Nursing activities on continuous renal replacement therapy in the intensive care units" 6 (6): 65-77, 2013

      16 Kane RL, "Nurse staffing and quality of patient care" 151 : 1-115, 2007

      17 Needleman J, "Nurse staffing and inpatient hospital mortality" 364 (364): 1037-1045, 2011

      18 Tsai TC, "National estimates of increase in US mechanical ventilator supply during the COVID-19 pandemic" 5 (5): e2224853-, 2022

      19 Kim YS, "Measures to improve ICU quality assessment" Health Insurance Review & Assessment Service 2021

      20 Health Insurance Review & Assessment Service(KR), "Health insurance reimbursement schedule 2009∼2020" Health Insurance Review & Assessment Service 2020

      21 Ministry of Health and Welfare (KR), "Enforcement rules of the medical service act. Ordinance of the Ministry of Health and Welfare No. 976"

      22 Ministry of Health and Welfare (KR), "Enforcement decree of the National Health Insurance Act. Presidential decree No. 34217"

      23 Han CH, "Current status of healthcare utilization, survival, and prognosis in critically ill patients using national health insurance claims data" National Health Insurance Service Ilsan Hospital Research Institute 2017

      24 Core Standards Working Party of the Joint Professional Standards Committee, "Core standards for intensive care units"

      25 Stevens JS, "Continuous renal replacement therapy and the COVID pandemic" 34 (34): 561-566, 2021

      26 김진현 ; 이은희 ; 김성재 ; 박진희 ; 박은태 ; 정수용, "Adequacy of nurse staffing level in integrated nursing care" 24 (24): 288-297, 2018

      27 Chamberlain D, "ACCCN workforce standards for intensive care nursing : systematic and evidence review, development, and appraisal" 31 (31): 292-302, 2018

      28 Shin YS, "A study on the third amendment of the resource-based relative value scale" Health Insurance Review & Assessment Service 2018

      29 이효진 ; 조성현 ; 심미영 ; 김정연 ; 송유길 ; 김진 ; 김영삼, "A study on appropriate nurse staffing levels in intensive care units and improvement of the critical care nursing fee schedules" 29 (29): 312-326, 2023

      30 Health Insurance Review & Assessment Service(KR), "2017 Health insurance claims data analysis manual" Health Insurance Review & Assessment Service 2017

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