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http://dx.doi.org/10.5953/JMJH.2022.29.1.41

Analysis of Factors Related to Mortality in Adult ICU Patients: Focusing on Nurse Staffing Level  

Lee, Jeong Mo (Division of Pulmonology and Department of Internal Medicine, National Health Insurance Service Ilsan Hospital)
Lee, Kwang Ok (Department of Nursing, Sangmyung University)
Hong, Jeong Hwa (Research and Analysis, National Health Insurance Service Ilsan Hospital)
Park, Hyun Hee (Operation Nursing, National Health Insurance Service Ilsan Hospital)
Publication Information
Journal of muscle and joint health / v.29, no.1, 2022 , pp. 41-49 More about this Journal
Abstract
Purpose: The purpose of this study was to assess the influence of nurses staffing level on patient health outcomes in intensive care units (ICUs) in Korea. Methods: The study was retrospective in nature. Information on patients and their outcomes, as well as nurse cohort data, were obtained from Korea's National Health Insurance Service Database. The observation 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: The mortality 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 hospitals with a 1~2 level. 28-day mortality rate was also higher at general hospitals with a level 3~4 (HR, 1.13; 95% confidence interval, 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 of healthcare-associated mortality in critically ICUs patients. Policies to achieve adequate nurse staffing levels are therefore required to enhance patient outcomes.
Keywords
Nurses; Staffing; Intensive care unit; Mortality; Hospitals;
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1 Kane, R. L., Shamliyan, T. A., Mueller, C., & Duval, S. (2007). Wilt T.J.. The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis. Medical Care, 45(12), 1195-1204. https://doi.org/10.1097/MLR.0b013e3181468ca3   DOI
2 Ch, S., & Yun, S. (2009). 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), 1092-1101. https://doi.org/10.1016/j.ijnurstu.2009.02.001   DOI
3 Costa, D. K., Wallace, D. J., & Kahn, J. M. (2015). 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), 2275-2282. https://doi.org/10.1097/CCM.0000000000001259   DOI
4 Frost, S. A., & Alexandrou, E. (2013). 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), 62-63. https://doi.org/10.1136/eb-2012-100893   DOI
5 Kim, J-H. (2018). Association of nurse staffing grade and 30-day mortality in intensive care units among cardiovascular disease patients. Medicine (Baltimore), 97(42), e12895. https://doi.org/10.1097/MD.0000000000012895   DOI
6 Lee, B. J., Lee, C., Kim, D. K., Kim, K. H., Kim, E., Park, T. Y., et al. (2010). The number of resident physicians and the mortality rate in a medical intensive care unit. Korean Journal of Internal Medicine, 79(2), 155-162.
7 Lee, H., & Bae, H. (2013) The association of nurse staffing levels and patient outcome in intensive care units. Korean Journal of Critical Care Medicine, 28(2), 75-79.   DOI
8 Kim, Y., Kim, H., & Cho, E. (2020). 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, 19:17. https://doi.org/10.1186/s12912-020-0410-7   DOI
9 Tucker, J. (2002). 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), 99-107. https://doi.org/10.1016/S0140-6736(02)07366-X   DOI
10 Shin, Y. S., Hwang, D. K., Kim, S. Y., & Park, K. Y. (2015). The study for improving differentiated inpatient nursing fees by staffing grades. Korea Institute for Health and Social Affairs. Report No.: G000CU1-2015-200.
11 Van den Heede, K., Lesaffre, E., Diya, L., Vleugels, A., Clarke, S. P., Aiken, L. H., et al. (2009). The relationship between inpatient cardiac surgery mortality and nurse numbers and educational level: Analysis of administrative data. International Journal of Nursing Studies, 46(6), 796-803. https://doi.org/10.1016/j.ijnurstu.2008.12.018   DOI
12 Organization for Economic Co-operation and Development. OECD health data [Internet]. OECD Health Statistics 2021 [cited 2021 July 2nd]. Available from: https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_REAC
13 Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., et al. (2018). 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, 17(1), 6-22. https://doi.org/10.1177/1474515117721561   DOI
14 Kiekkas, P., Sakellaropoulos, G. C., Brokalaki, H., Manolis, E., Samios, A., Skartsani, C., et al. (2008). Association between nursing workload and mortality of intensive care unit patients. Journal of Nursing Scholarsh, 40(4), 385-90. https://doi.org/10.1111/j.1547-5069.2008.00254.x   DOI
15 Law, A. C., Stevens, J. P., Hohmann, S., & Walkey, A. J. (2018). Patient outcomes after the introduction of statewide ICU nurse staffing regulations. Intensive Care Medicine, 46(10), 1563-1569. https://doi.org/10.1097/CCM.0000000000003286   DOI
16 Ministry of Health and Welfare. Revision of medical care benefits and relative value scale. 2015(2015-2145). https://doi.org/10.4332/KJHPA.2007.17.3.001   DOI
17 Neuraz, A., Guerin, C., Payet, C., Polazzi, S., Aubrun, F., & Dailler, F., et al. (2015). Patient mortality is associated with staff resources and workload in the ICU: A Multicenter Observational Study. Critical Care Medicine, 43(8), 1587-1594.   DOI
18 Cho, J., Lee, H. J., Hong, S., Suh, G.Y., Park, M. S., Kim, S. C., et al. (2012). Structure of intensive care unit and clinical outcomes in critically ill patients with influenza A/H1N1 2009. The Korean Journal of Critical Care Medicine, 27(2), 65-69. https://doi.org/10.4266/kjccm.2012.27.2.65   DOI
19 National Health Insurance Ilsan Hospital Research Institute, Status of Adult Intensive Care Unit Use by Severity and analysis of medical treatment status by nursing institution, Research Report 2020-20-011. Available from: https://www.alio.go.kr/item/itemOrganList.do?apbaId=C0459&reportFormRootNo=B1040
20 Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., & Zelevinsky, K. (2002). Nurse-staffing levels and the quality of care in hospitals. New England Journal of Medicine, 346(22), 1715-1722. https://doi.org/10.1056/NEJMsa012247   DOI
21 Tarnow-Mordi, W. O., Hau, C., Warden, A., & Shearer, A. J. (2000). Hospital mortality in relation to staff workload: A 4-year study in an adult intensive-care unit. The Lancet, 356(9225), 185-189. https://doi.org/10.1016/S0140-6736(00)02478-8   DOI
22 Youn, K. (2017). The effects of nurse staffing and skill mix on in-hospital mortality in the hospitals with different Characteristics. Journal of Health Informatics and Statistics, 42(1), 27-35. https://doi.org/10.21032/jhis.2017.42.1.27   DOI
23 Park, J., Jeon, K., Chung, C. R., Yang, J. H., Cho, Y. H., Cho, J., et al. (2018). A nationwide analysis of intensive care unit admissions, 2009-2014-The Korean ICU National Data (KIND) study. Journal of Critical Care, 44, 24-30. https://doi.org/10.1016/j.jcrc.2017.09.017   DOI