Nurse staffing practices and adverse events in acute care hospitals: The research protocol of a multisite patient-level longitudinal study.

We describe an innovative research protocol to: (a) examine patient-level longitudinal associations between nurse staffing practices and the risk of adverse events in acute care hospitals and; (b) determine possible thresholds for safe nurse staffing. A dynamic cohort of adult medical, surgical and intensive care unit patients admitted to 16 hospitals in Quebec (Canada) between January 2015-December 2019. Patients in the cohort will be followed from admission until 30-day postdischarge to assess exposure to selected nurse staffing practices in relation to the subsequent occurrence of adverse events. Five staffing practices will be measured for each shift of an hospitalization episode, using electronic payroll data, with the following time-varying indicators: (a) nursing worked hours per patient; (b) skill mix; (c) overtime use; (d) education mix and; and (e) experience. Four high-impact adverse events, presumably associated with nurse staffing practices, will be measured from electronic health record data retrieved at the participating sites: (a) failure-to-rescue; (b) in-hospital falls; (c) hospital-acquired pneumonia and; and (d) venous thromboembolism. To examine the associations between the selected nurse staffing exposures and the risk of each adverse event, separate multivariable Cox proportional hazards frailty regression models will be fitted, while adjusting for patient, nursing unit and hospital characteristics, and for clustering. To assess for possible staffing thresholds, flexible non-linear spline functions will be fitted. Funding for the study began in October 2019 and research ethics/institutional approval was granted in February 2020. To our knowledge, this study is the first multisite patient-level longitudinal investigation of the associations between common nurse staffing practices and the risk of adverse events. It is hoped that our results will assist hospital managers in making the most effective use of the scarce nursing resources and in identifying staffing practices that minimize the occurrence of adverse events. 目的: 我们描述了一份创新的研究方案: (a) 检查急诊护理医院护士配置方法与不良事件风险之间的患者水平纵向关联; (b) 确定安全护士配置的可能阈值。 设计: 2015年1月至2019年12月期间, 魁北克省 (加拿大) 16家医院收治的成人医疗、外科和重症监护病房患者动态队列研究。 方法: 将从入院到出院后30天里, 对队列研究中的患者进行随访, 以评估与随后发生的不良事件相关的选定护士工作实践的暴露情况。将使用电子工资单数据, 测量住院期间各轮班的五种人员配置方法, 并采用以下时变指标: (a) 各患者的护理工作时间; (b) 技能混合; (c) 加班使用; (d) 教育混合和; 以及 (e) 经验。将从参与站点检索的电子健康记录数据中测量四个可能与护士配置方法相关的高影响不良事件: (a) 抢救失败; (b) 住院量下降; (c) 院内获得性肺炎和; 以及 (d)静脉血栓栓塞。为检测所选护士人员配置暴露与各种不良事件风险之间的关系, 将拟合单独的多变量Cox比例风险脆弱性回归模型, 同时调整患者、护理单位和医院特征, 并进行聚类分析。为评估可能的人员配置阈值, 将拟合灵活的非线性样条函数。我们于2019年10月, 获得该项研究的资助,于2020年2月获得研究伦理/机构的批准。 讨论: 据我们所知, 此项研究是第一次多地点患者水平的纵向调查, 其针对普通护士配置方法与不良事件风险之间的关联。希望我们的研究结果能帮助医院管理者最有效地利用稀缺的护理资源, 并找出减少不良事件发生的人员配置方法。.

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