During the Covid-19 pandemic, Covid-19 mortality varied depending on the hospital where patients were admitted, but it is unknown what aspects of hospitals were important for mitigating preventable deaths. To determine whether hospital differences in pre-pandemic and during pandemic nursing resources—average patient-to-registered nurse (RN) staffing ratios, proportion of bachelor-qualified RNs, nurse work environments, Magnet recognition—explain differences in risk-adjusted Covid-19 mortality; and to estimate how many deaths may have been prevented if nurses were better resourced prior to and during the pandemic. This is a cross-sectional study of 87,936 Medicare beneficiaries (65–99 years old) hospitalized with Covid-19 and discharged (or died) between April 1 and December 31, 2020, in 237 general acute care hospitals in New York and Illinois. Measures of hospital nursing resources (i.e. patient-to-RN staffing ratios, proportion of bachelor-qualified RNs, nurse work environments, Magnet recognition) in the pre-pandemic period (December 2019 to February 2020) and during (April to June 2021) were used to predict in-hospital and 30-day mortality using adjusted logistic regression models. The mean age of patients was 78 years (8.6 SD); 51 % were male (n = 44,998). 23 % of patients admitted to the hospital with Covid-19 died during the hospitalization (n = 20,243); 31.5 % died within 30-days of admission (n = 27,719). Patients admitted with Covid-19 to hospitals with better nursing resources pre-pandemic and during the pandemic were statistically significantly less likely to die. For example, each additional patient in the average nurses' workload pre-pandemic was associated with 20 % higher odds of in-hospital mortality (OR 1.20, 95 % CI [1.12–1.28], p < 0.001) and 15 % higher odds of 30-day mortality (OR 1.15, 95 % CI [1.09–1.21], p < 0.001). Hospitals with greater proportions of BSN-qualified RNs, better quality nurse work environments, and Magnet recognition offered similar protective benefits to patients during the pandemic. If all hospitals in the study had superior nursing resources prior to or during the pandemic, models estimate many thousands of deaths among patients hospitalized with Covid-19 could have been avoided. Patients with Covid-19 admitted to hospitals with adequate numbers of RNs caring for patients, a workforce rich in BSN-qualified RNs, and high-quality nurse work environments (both prior to and during the Covid-19 pandemic) were more likely to survive the hospitalization. Bolstering these hospital nursing resources during ordinary times is necessary to ensure better patient outcomes and emergency-preparedness of hospitals for future public health emergencies.

中文翻译：

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医院护士人员配置变化与 Covid-19 死亡：一项横断面研究


在 Covid-19 大流行期间，Covid-19 死亡率因收治患者的医院而异，但尚不清楚医院的哪些方面对于减少可预防的死亡很重要。确定医院在大流行前和大流行期间护理资源方面的差异（平均患者与注册护士（RN）人员配置比例、具有学士学位资格的注册护士的比例、护士工作环境、磁力识别）是否可以解释风险调整后的Covid-19的差异。 19 死亡；并估计如果在大流行之前和期间为护士提供更好的资源，可以避免多少死亡。这是一项横断面研究，调查对象为 2020 年 4 月 1 日至 12 月 31 日期间在纽约州和伊利诺伊州 237 家普通急症护理医院因 Covid-19 住院并出院（或死亡）的 87,936 名医疗保险受益人（65-99 岁）。疫情前（2019年12月至2020年2月）和疫情期间（2021年4月至2021年6月）医院护理资源的衡量（即患者与注册护士的人员配置比例、本科学历注册护士的比例、护士工作环境、磁力识别）使用调整后的逻辑回归模型来预测院内死亡率和 30 天死亡率。患者的平均年龄为 78 岁 (8.6 SD)； 51% 为男性 (n = 44,998)。因 Covid-19 入院的患者中有 23% 在住院期间死亡（n = 20,243）； 31.5% 的患者在入院后 30 天内死亡（n = 27,719）。在大流行前和大流行期间，在拥有更好护理资源的医院收治的 Covid-19 患者的死亡可能性在统计上显着降低。例如，大流行前护士平均工作量中每增加一名患者，院内死亡率就会增加 20%（OR 1.20，95% CI [1.12–1.28]，p < 0.001），30 天死亡率增加 15%（OR 1.15，95% CI [1.09–1.21]，p < 0.001）。拥有更多 BSN 合格注册护士比例、更好质量的护士工作环境和 Magnet 认可的医院在大流行期间为患者提供了类似的保护福利。如果研究中的所有医院在大流行之前或期间都拥有优质的护理资源，模型估计，数千例因 Covid-19 住院的患者死亡是可以避免的。如果医院有足够数量的注册护士来照顾患者、拥有丰富的符合 BSN 资格的注册护士以及高质量的护士工作环境（在 Covid-19 大流行之前和期间），那么 Covid-19 患者的生存可能性就更大住院治疗。有必要在平时加强这些医院护理资源，以确保更好的患者治疗效果以及医院为未来突发公共卫生事件做好应急准备。