BACKGROUND Nurses play a crucial role in maintaining the safety of surgical patients. Few nurse staffing studies have looked specifically at surgical patients to examine the impact of exposure to low staffing on patient outcomes. METHODS A longitudinal patient analysis was conducted in four organizations in England using routine data from 213 910 admissions to all surgical specialties. Patients' staffing exposures were modelled as counts of understaffed registered nurse and nurse assistant days in the first 5 inpatient days. Understaffing was identified when staffing per patient-day was below the mean for the ward. Cox models were used to examine mortality within 30 days of admission and readmission within 30 days of discharge. Generalized linear models were used to investigate duration of hospital stay and occurrence of hospital-acquired conditions. RESULTS Increased exposure to registered nurse understaffing was associated with longer hospital stay and increased risk of deep vein thrombosis, pneumonia, and pressure ulcers. This was also true for nurse assistant understaffing, but the effect sizes tended to be smaller. In the Cox models, there were similarly increased hazards of death for registered nurse understaffing (HR 1.09, 95% c.i. 1.07 to 1.12) and nurse assistant understaffing (HR 1.10, 1.08 to 1.13), whereas the effect size of registered nurse understaffing for readmission (HR 1.02, 1.02 to 1.03) was greater than that seen with nurse assistants (HR 1.01, 1.01 to 1.02). CONCLUSION Understaffing by both registered nurses and nursing assistants is associated with increased risks of a range of adverse events, and generally larger effects are seen with registered nurse understaffing.

中文翻译：

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护士人手不足与手术入院的不良结局相关。


背景 护士在维护手术患者的安全方面发挥着至关重要的作用。很少有护士人员配备研究专门针对手术患者，以检查暴露于人员配备不足对患者预后的影响。方法 使用来自 213 910 名所有外科专业入院的常规数据，在英格兰的四个组织中进行了纵向患者分析。患者的人员配备暴露被建模为前 5 个住院日中人手不足的注册护士和护士助理天数。当每个患者日的人员配备低于病房的平均值时，就会发现人员不足。使用 Cox 模型检查入院后 30 天内的死亡率和出院后 30 天内的再入院率。广义线性模型用于调查住院时间和医院获得性疾病的发生率。结果 注册护士人手不足的风险增加与住院时间延长以及深静脉血栓形成、肺炎和压疮风险增加有关。护士助理人手不足也是如此，但效应量往往较小。在 Cox 模型中，注册护士人手不足（HR 1.09,95% ci 1.07 至 1.12）和护士助理人手不足（HR 1.10,1.08 至 1.13）的死亡风险同样增加，而注册护士人手不足再入院的效应量（HR 1.02,1.02 至 1.03）大于护士助理（HR 1.01， 1.01 到 1.02）。结论 注册护士和护理助理的人员配备不足与一系列不良事件的风险增加有关，通常注册护士人员配备不足的影响更大。