DOI QR코드

DOI QR Code

간호사 확보수준이 입원 환자의 병원사망과 입원 30일 이내 사망에 미치는 영향

Effects of Nurse Staffing Level on In-hospital Mortality and 30-day Mortality after Admission using Korean National Health Insurance Data

  • 투고 : 2022.01.31
  • 심사 : 2022.02.24
  • 발행 : 2022.04.30

초록

Purpose: The purpose of this study is to investigate the association between the nurse staffing level and the patient mortality using Korean National Health Insurance data. Methods: The data of 1,068,059 patients from 913 hospitals between 2015 and 2016 were analyzed. The nurse staffing level was categorized based on the bed-to-nurse ratio in general wards, intensive care units (ICUs), and hospitals overall. The x2 test and generalized estimating equations (GEE) multilevel multivariate logistic regression analyses were used to explore in-hospital mortality and 30-day mortality after admission. Results: The in-hospital mortality rate was 2.9% and 30-day mortality after admission rate was 3.0%. Odd Ratios (ORs) for in-hospital mortality were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.72, 95% CI=0.63~0.84) and in ICUs with a bed-to-nurse ratio of less than 0.88 compared to that with 1.25 or more (OR=0.78, 95% CI=0.66~0.92). ORs for 30-day mortality after admission were statistically lower in general wards with a bed-to-nurse ratio of less than 3.5 compared to that with 6.0 or more (OR=0.83, 95% CI=0.73~0.94) and in ICUs with a bed-to-nurse ratio of less than 0.63 compared to that with 1.25 or more (OR=0.85, 95% CI=0.72~1.00). Conclusion: To reduce the patient mortality, it is necessary to ensure a sufficient number of nurses by improving the nursing fee system according to the nurse staffing level.

키워드

과제정보

본 연구는 2021년 병원간호사회에서 연구비를 지원받아 진행한 연구임.

참고문헌

  1. Kim Y, Kim SY, Lee K. Association between registered nurse staffing levels and in-hospital mortality in craniotomy patients using Korean National Health Insurance data. BMC Nursing. 2020;19:36. https://doi.org/10.1186/s12912-020-00430-0
  2. Lee KA, Lee SH. A comparative study on the operation status of comprehensive nursing care ward. Journal of Muscle and Joint Health. 2018;25(3):196-204. https://doi.org/10.5953/JMJH.2018.25.3.196
  3. International Council of Nurses. Position Statement: Evidencebased safe nurse staffing [Internet]. Geneva: International Council of Nurses; 2009 [adopted 2018; cited 2020 Oct 1]. Available from: https://www.icn.ch/sites/default/files/inline-files/ICN%20PS%20Evidence%20based%20safe%20nurse%20staffing_0.pdf.
  4. Aiken LH, Cimiotti JP, Sloane DM, Smith HL, Flynn L, Neff DF. Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments. Medical Care. 2011;49(12):1047-1053. https://doi.org/10.1097/MLR.0b013e3182330b6e
  5. Friese CR, Lake ET, Aiken LH, Silber JH, Sochalski J. Hospital nurse practice environments and outcomes for surgical oncology patients. Health Services Research. 2008;43(4):1145-1163. https://doi.org/10.1111/j.1475-6773.2007.00825.x
  6. Kane RL, Shamliyan T, Mueller C, Duval S, Wilt TJ. Nurse staffing and quality of patient care. Evidence Report/Technology Assessment No.151 (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290-02-0009) [Internet]. Rockville (MD): Agency for Healthcare Research and Quality; 2007 Mar. [cited 2022 Feb 01]. AHRQ Publication No. 07-E005. Available from: https://archive.ahrq.gov/downloads/pub/evidence/pdf/nursestaff/nursestaff.pdf.
  7. Driscoll A, Grant MJ, Carroll D, Dalton S, Deaton C, Jones I, et al. The effect of nurse-to-patient ratios on nurse-sensitive patient outcomes in acute specialist units: A systematic review and meta-analysis. European Journal of Cardiovascular Nursing. 2018;17(1):6-22. https://doi.org/10.1177/1474515117721561
  8. Cho SH, Kim YS, Yeon KN, You SJ, Lee ID. Effects of increasing nurse staffing on missed nursing care. International Nursing Review. 2015;62(2):267-274. https://doi.org/10.1111/inr.12173
  9. Cho SH, Hwang JH, Kim J. Nurse staffing and patient mortality in intensive care units. Nursing Research. 2008;57(5):322-330. https://doi.org/10.1097/01.NNR.0000313498.17777.71
  10. Cho SH, Yun SC. 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. 2009;46(8):1092-1101. https://doi.org/10.1016/j.ijnurstu.2009.02.001
  11. Lasater KB, McHugh M, Rosenbaum PR, Aiken LH, Smith H, Reiter JG, et al. Valuing hospital investments in nursing: Multistate matched-cohort study of surgical patients. BMJ Quality & Safety. 2021;30(1):46-55. https://doi.org/10.1136/bmjqs-2019-010534
  12. Kim Y, Cho SH, June KJ, Shin SA, Kim J. Effects of hospital nurse staffing on in-hospital mortality, pneumonia, sepsis, and urinary tract infection in surgical patients. Journal of Korean Academy of Nursing. 2012;42(5):719-729. https://doi.org/10.4040/jkan.2012.42.5.719
  13. Cho E, Sloane DM, Kim EY, Kim S, Choi M, Yoo IY, et al. Effects of nurse staffing, work environments, and education on patient mortality: An observational study. International Journal of Nursing Studies. 2015;52(2):535-542. https://doi.org/10.1016/j.ijnurstu.2014.08.006
  14. Cho SH, Hong KJ, Lee JY. Estimation of revenue growth generated by changing nurse staffing grades and fees and introducing night shift nursing fees. Journal of Korean Academy Nursing Administration. 2021;27(3):191-203. https://doi.org/10.11111/jkana.2021.27.3.191
  15. Organisation for Economic Co-operation and Development. OECD.Sat: Health care resources: Nurses [Internet]. Paris: OECD; 2021 [cited 2021 July 10]. Available from: https://stats.oecd.org.
  16. Kim Y, Kim HY. Retention rates and the associated risk factors of turnover among newly hired nurses at South Korean hospitals: A retrospective cohort study. International Journal of Environmental Research and Public Health. 2021;18(19):10013. https://doi.org/10.3390/ijerph181910013
  17. Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. American Journal of Epidemiology. 2011;173(6):676-682. https://doi.org/10.1093/aje/kwq433
  18. Aiken LH, Sloane DM, Cimiotti JP, Clarke SP, Flynn L, Seago JA, et al. Implications of the California nurse staffing mandate for other states. Health Services Research. 2010;45(4):904-921. https://doi.org/10.1111/j.1475-6773.2010.01114.x
  19. National Health Insurance Service. 2016 health insurance key statistics [Internet]. Wonju: National Health Insurance Service; 2017 Feb 28 [cited 2021 Jun 20]. Available from: https://www.nhis.or.kr/nhis/together/wbhaec06400m01.do?mode=view&articleNo=123062&article.offset=10&articleLimit=10.
  20. McHugh MD, Aiken LH, Sloane DM, Windsor C, Douglas C, Yates P. Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: A prospective study in a panel of hospitals. Lancet. 2021;397(10288):1905-1913. https://doi.org/10.1016/S0140-6736(21)00768-6
  21. Korea Health Industry Development Institute. National health care survey(11-1352000-000524-13). Cheongju: Korea Health Industry Development Institute; 2017.
  22. Kim Y, Kim HY, Cho E. Association between the bed-to-nurse ratio and 30-day post-discharge mortality in patients undergoing surgery: A cross-sectional analysis using Korean administrative data. BMC Nursing. 2020;19:17. https://doi.org/10.1186/s12912-020-0410-7
  23. Cho SH, Lee JY, June KJ, Hong KJ, Kim Y. Nurse staffing levels and proportion of hospitals and clinics meeting the legal standard for nurse staffing for 1996-2013. Journal of Korean Academy Nursing Administration. 2016;22(3):209-219. https://doi.org/10.11111/jkana.2016.22.3.209
  24. Kim JH, Ha SK, Park YW, Kim YH, Yi SM, Kwon HJ. Nurse wage structure and its determinants in hospital industry. Journal of Korean Clinical Nursing Research. 2019;25(3):294-302. https://doi.org/10.22650/JKCNR.2019.25.3.294