PDF(Pubmed)
Abstract：
OBJECTIVE: To describe the associations between patient-to-nurse staffing ratios and rates of mortality, process of care events and vital sign documentation.
METHODS: Secondary analysis of data from the evaluating processes of care and outcomes of children in hospital (EPOCH) cluster-randomised trial.
METHODS: 22 hospitals caring for children in Canada, Europe and New Zealand.
METHODS: Eligible hospitalised patients were aged>37 weeks and <18 years.
METHODS: The primary outcome was all-cause hospital mortality. Secondary outcomes included five events reflecting the process of care, collected for all EPOCH patients; the frequency of documentation for each of eight vital signs on a random sample of patients; four measures describing nursing perceptions of care.
RESULTS: A total of 217 714 patient admissions accounting for 849 798 patient days over the course of the study were analysed. The overall mortality rate was 1.65/1000 patient discharges. The median (IQR) number of patients cared for by an individual nurse was 3.0 (2.8-3.6). Univariate Bayesian models estimating the rate ratio (RR) for the patient-to-nurse ratio and the probability that the RR was less than one found that a higher patient-to-nurse ratio was associated with fewer clinical deterioration events (RR=0.88, 95% credible interval (CrI) 0.77-1.03; P (RR<1)=95%) and late intensive care unit admissions (RR=0.76, 95% CrI 0.53-1.06; P (RR<1)=95%). In adjusted models, a higher patient-to-nurse ratio was associated with lower hospital mortality (OR=0.77, 95% CrI=0.57-1.00; P (OR<1)=98%). Nurses from hospitals with a higher patient-to-nurse ratio had lower ratings for their ability to influence care and reduced documentation of most individual vital signs and of the complete set of vital signs.
CONCLUSIONS: The data from this study challenge the assumption that lower patient-to-nurse ratios will improve the safety of paediatric care in contexts where ratios are low. The mechanism of these effects warrants further evaluation including factors, such as nursing skill mix, experience, education, work environment and physician staffing ratios.
BACKGROUND: EPOCH clinical trial registered on clinical trial.gov NCT01260831; post-results.
METHODS: Secondary analysis of data from the evaluating processes of care and outcomes of children in hospital (EPOCH) cluster-randomised trial.
METHODS: 22 hospitals caring for children in Canada, Europe and New Zealand.
METHODS: Eligible hospitalised patients were aged>37 weeks and <18 years.
METHODS: The primary outcome was all-cause hospital mortality. Secondary outcomes included five events reflecting the process of care, collected for all EPOCH patients; the frequency of documentation for each of eight vital signs on a random sample of patients; four measures describing nursing perceptions of care.
RESULTS: A total of 217 714 patient admissions accounting for 849 798 patient days over the course of the study were analysed. The overall mortality rate was 1.65/1000 patient discharges. The median (IQR) number of patients cared for by an individual nurse was 3.0 (2.8-3.6). Univariate Bayesian models estimating the rate ratio (RR) for the patient-to-nurse ratio and the probability that the RR was less than one found that a higher patient-to-nurse ratio was associated with fewer clinical deterioration events (RR=0.88, 95% credible interval (CrI) 0.77-1.03; P (RR<1)=95%) and late intensive care unit admissions (RR=0.76, 95% CrI 0.53-1.06; P (RR<1)=95%). In adjusted models, a higher patient-to-nurse ratio was associated with lower hospital mortality (OR=0.77, 95% CrI=0.57-1.00; P (OR<1)=98%). Nurses from hospitals with a higher patient-to-nurse ratio had lower ratings for their ability to influence care and reduced documentation of most individual vital signs and of the complete set of vital signs.
CONCLUSIONS: The data from this study challenge the assumption that lower patient-to-nurse ratios will improve the safety of paediatric care in contexts where ratios are low. The mechanism of these effects warrants further evaluation including factors, such as nursing skill mix, experience, education, work environment and physician staffing ratios.
BACKGROUND: EPOCH clinical trial registered on clinical trial.gov NCT01260831; post-results.
摘要：
目的：描述患者与护士的人员配备比率与死亡率之间的关系，护理事件和生命体征文档的过程。
方法：对住院儿童（EPOCH）整群随机试验的护理和结局评估过程中的数据进行二次分析。
方法：加拿大22家照顾儿童的医院，欧洲和新西兰。
方法：符合条件的住院患者年龄>37周且<18岁。
方法：主要结局是全因住院死亡率。次要结果包括反映护理过程的五个事件，为所有EPOCH患者收集；随机样本患者中八个生命体征中每个体征的记录频率；描述护理观念的四个指标。
结果：在研究过程中，共分析了217714例患者入院，占849798例患者天。总死亡率为1.65/1000患者出院。由个别护士护理的患者中位数（IQR）为3.0（2.8-3.6）。估计患者与护士比率的比率（RR）和RR小于1的概率的单变量贝叶斯模型发现，较高的患者与护士比率与较少的临床恶化事件（RR=0.88，95％可信间隔（CrI）0.77-1.03；P（RR<1）=95％）和晚期重症监护病房入院（RR=0.76，95％CrI0.53-1.06）（P=1）。在调整后的模型中，较高的患者-护士比率与较低的住院死亡率相关(OR=0.77,95%CrI=0.57~1.00;P(OR<1)=98%).来自患者与护士比率较高的医院的护士对影响护理的能力的评分较低，并且减少了对大多数个人生命体征和完整生命体征的记录。
结论：这项研究的数据挑战了以下假设：在比率较低的情况下，较低的患者与护士比率将提高儿科护理的安全性。这些影响的机制值得进一步评估，包括因素，比如护理技能组合，经验,教育,工作环境和医生人员配备比例。
背景：在临床试验.govNCT01260831上注册的EPOCH临床试验；后结果。
方法：对住院儿童（EPOCH）整群随机试验的护理和结局评估过程中的数据进行二次分析。
方法：加拿大22家照顾儿童的医院，欧洲和新西兰。
方法：符合条件的住院患者年龄>37周且<18岁。
方法：主要结局是全因住院死亡率。次要结果包括反映护理过程的五个事件，为所有EPOCH患者收集；随机样本患者中八个生命体征中每个体征的记录频率；描述护理观念的四个指标。
结果：在研究过程中，共分析了217714例患者入院，占849798例患者天。总死亡率为1.65/1000患者出院。由个别护士护理的患者中位数（IQR）为3.0（2.8-3.6）。估计患者与护士比率的比率（RR）和RR小于1的概率的单变量贝叶斯模型发现，较高的患者与护士比率与较少的临床恶化事件（RR=0.88，95％可信间隔（CrI）0.77-1.03；P（RR<1）=95％）和晚期重症监护病房入院（RR=0.76，95％CrI0.53-1.06）（P=1）。在调整后的模型中，较高的患者-护士比率与较低的住院死亡率相关(OR=0.77,95%CrI=0.57~1.00;P(OR<1)=98%).来自患者与护士比率较高的医院的护士对影响护理的能力的评分较低，并且减少了对大多数个人生命体征和完整生命体征的记录。
结论：这项研究的数据挑战了以下假设：在比率较低的情况下，较低的患者与护士比率将提高儿科护理的安全性。这些影响的机制值得进一步评估，包括因素，比如护理技能组合，经验,教育,工作环境和医生人员配备比例。
背景：在临床试验.govNCT01260831上注册的EPOCH临床试验；后结果。
