| 제목 | The effect of bed-to-nurse ratio on hospital mortality of critically ill children on mechanical ventilation: a nationwide population-based study | ||
|---|---|---|---|
| 작성자 | 관리자 | 등록일 | 2022-04-20 |
내용
The effect of bed-to-nurse ratio on hospital mortality of critically ill children on mechanical ventilation: a nationwide population-based study
Minyoung Jung 1, Hyejeong Park 2 3, Danbee Kang 3 4, Esther Park 2, Kyeongman Jeon 2, Chi Ryang Chung 2, Jeong Hoon Yang 2, Gee Young Suh 2 3, Eliseo Guallar 3 5, Juhee Cho 3 4, Joongbum Cho 6
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- PMID: 33257997
- PMCID: PMC7703514
- DOI: 10.1186/s13613-020-00780-7
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Abstract
Background: Despite the high workload of mechanical ventilation, there has been a lack of studies on the association between nurse workforce and mortality in mechanically ventilated patients. We evaluated the association of the bed-to-nurse ratio with mortality in ventilated pediatric patients admitted to an intensive care unit (ICU).
Methods: We conducted a nationwide retrospective analysis by using the Korean National Health Insurance database, which categorizes the bed-to-nurse ratio into 9 grades according to the number of beds divided by the number of full-time equivalent registered nurses in a unit. Patients of ages between 28 days and 18 years were enrolled. Multiple admissions and transfers from other hospitals were excluded. We evaluated the odds ratios (ORs) of in-hospital mortality using 4 groups (Grade 1: bed-to-nurse < 0.50, Grade 2: < 0.63, Grade 3: < 0.77, Grade 4 or above > 0.77) with adjustment of patient factors, hospital factors, and treatment requirements.
Results: Of the 27,849 patients admitted to ICU, 11,628 (41.8%) were on mechanical ventilation. The overall in-hospital mortality rates in Grade 1, Grade 2, Grade 3, and Grade 4 or above group were 4.5%, 6.8%, 6.9%, and 4.7%, respectively. The adjusted ORs (95% CI) for in-hospital mortality of mechanically ventilated patients in the Grade 2, Grade 3, and Grade 4 or above compared to those in Grade 1 were 2.73 (95% CI 1.51-4.95), 4.02 (95% CI 2.23-7.26), and 7.83 (4.07-15.07), respectively. However, for patients without mechanical ventilation, the adjusted ORs of in-hospital mortality were not statistically significant.
Conclusion: In mechanically ventilated patients, the adjusted mortality rate increased significantly, as the bed-to-nurse ratio of the ICU increased. Policies that limit the number of ventilated patients per nurse should be considered. Trial registration retrospectively registered.
Keywords: Critical care; Critical care outcomes; Epidemiology; Mechanical ventilation; Mortality; National Health Insurance; Nurse staffing; Pediatric intensive care units; Quality of care.
