Role of nurses in improving patient safety: Evidence from surgical complications in 21 countries

Objectives: To analyze the role of nurse staffing in improving patient safety due to reducing surgical complications in member countries of Organization for Economic Co-operation and Development (OECD).Methods: The number of practicing nurses' density per 1000 population and five surgical complications indicators including foreign body left in during procedure (FBL),postoperative pulmonary embolism (PPE) and deep vein thrombosis (DVT) after hip and knee replacement,postoperative sepsis after abdominal surgery (PSA) and postoperative wound dehiscence (PWD) were collected in crude rates per 100,000 hospital discharges for age group of 15 years old and over within 30 days after surgery based on surgical admission-related and all admission-related methods.The observations of 21 OECD countries were collected from OECD Health Statistics during 2010-2015 period.The statistical technique of panel data analysis including unit root test,co-integration test and dynamic long-run analysis were used to estimate the possible relationship between our panel series.Results: There were significant relationships from nurse-staffing level to reducing FBL,PPE,DVT,PSA and PWD with long-run magnitudes of-2.91,-1.30,-1.69,-2.81 and-1.12 based on surgical admission method as well as-6.12,-14.57,-7.29,-1.41 and-0.88 based on all admission method,respectively.Conclusions: A higher proportion of nurses is associated with higher patient safety resulting from lower surgical complications and adverse clinical outcomes in OECD countries.Hence,we alert policy makers about the risk of underestimating the impact of nurses on improving patient safety as well as the quality of health care services in OECD countries.

Impact of nurse staffing on reducing infant, neonatal and perinatal mortality rates: Evidence from panel data analysis in 35 OECD countries

Objectives:To investigate the magnitude of effect nurse staffing had on decreasing the newborn mortality rates in member countries of Organisation for Economic Co-operation and Development(OECD).Methods:The statistical technique of panel data analysis was applied to explore the possibility of association between the number of nurses'density per 1,000 population and infant,neonatal and perinatal mortality rates(IMR,NMR and PMR)per 1000 births.The observations of 35 OECD countries were collected over the period of 2000 through 2016.Results:There were significant associations between nurse staffing and IMR,NMR and PMR i.e.a 1%increase in nurse-staffing level reduced IMR,NMR and PMR by 0.98%,0.97%and 0.96%,respectively.Furthermore,the role of nursing-related services in declining the average of newborn mortality rates were investigated at the highest level in Slovenia(-5.50),Sweden(-3.34),Iceland(-2.51),Czech Republic(-1.86),Japan(-1.64)and Finland(-1.64).Moreover,if the current relationship between nursestaffing level and newborn mortality rates are disturbed with nursing shortage(e.g.in Slovak Republic and Israel),then it takes about 17 years for the mortality rates to reduce and restore back to the previous equilibrium.Conclusions:A higher proportion of nurses'density per 1,000 population is associated with lower newborn mortality rates.In addition,the nursing-related services of Slovenia,Sweden,Iceland,Czech Republic,Japan and Finland with the highest impact on improving the health level of newborns would be good patterns for other developed countries in maternity and child health care.

护理人力配置水平和急性期照护质量:基于经合组织国家的面板数据分析

目的很多研究评估了护理人力配备水平对急性期照护质量的影响,但结论尚有争议。本研究旨在利用在经合组织26个国家的跨国统计数据,调查长时期内医院护理人力配备水平对提高急性期照护质量的影响程度。方法护理人力配备水平以每千人口的执业护士人数计算。急性期照护质量以3项医疗质量指标表示,分别为急性心肌梗死、出血性卒中和缺血性卒中3种疾病的30天病死率。这些数据都来自26个经合组织国家2005年至2015年的卫生统计资料。结果护理人力配备水平明显提高了医疗质量指标:护理人力配置水平每增加1%,将使急性心肌梗死、出血性卒中和缺血性卒中3种疾病病死率分别降低0.65%,0.60%和0.80%。此外,护理人力配置水平在提高总体医疗质量指标方面的作用以瑞典最为明显(-3.53),其次是丹麦(-3.31)、加拿大(-2.59)、荷兰(-2.33)、芬兰(-2.09)、瑞士(-1.72)、澳大利亚(-1.64)和美国(-1.53)。结论较高比例的护理人力配备水平与经合组织国家更好的急性期照护绩效相关。瑞典、丹麦、加拿大、荷兰、芬兰、瑞士、澳大利亚和美国的护理人力配备可作为其他国家的良好模式,降低急性病患者并发症、病死率和不良临床结果。

Analyzing economic feasibility for investing in nursing care: Evidence from panel data analysis in 35 OECD countries

Objective:To analyze economic feasibility for investing in nursing care.Method:The number of practicing nurses'density per 1000 population as a proxy for nursing staff and Gross Domestic Product(GDP)per capita(current US$)were collected in 35 member countries of Organization for Economic Co-operation and Development(OECD)over 2000-2016 period.The statistical technique of panel data analysis including unit root test,cointegration analysis,Granger causality test,dynamic long-run model analysis and error correction model were applied to measure economic impact of nursing-related services.Results:There was a committed bilateral relationship between nurse-staffing level and GDP with longrun magnitudes of 1.39 and 0A1 for GDP-lead-nurse and nurse-lead-GDP directions in OECD countries,respectively.Moreover,the highest long-run magnitudes of the effect nursing staff has on increasing GDP per capita were calculated in Finland(2.07),Sweden(1.92),Estonia(1.68),Poland(1.52),Czech Republic(1.48),Norway(1.47)and Canada(1.24).Conclusion:Our findings verify that although the dependency of nursing characteristics to GDP per capita is higher than the reliance of GDP to number of nurses'density per 1000 population,investing in nursing care is economically feasible in OECD countries i.e.nursing is not only a financial burden(or cost)on health care systems,but also an economic stimulus in OECD countries.Hence,we alert governments and policy makers about the risk of underestimating the economic impacts of nurses on economic systems of OECD countries.

Nurse staffing and life expectancy at birth and at 65 years old:Evidence from 35 OECD countries

Objective: To measure the possible magnitude of the role nurse staffing has on increasing life expectancy at birth and at 65 years old.Methods: The statistical technique of panel data analysis was applied to investigate the relationship from the number of practicing nurses' density per 1000 population to life expectancy at birth and at 65 years old.Five control variables were used as the proxies for the levels of medical staffing,health care financial and physical resources,and medical technology.The observations of 35 member countries of Organization for Economic Co-operation and Development (OECD) were collected from OECD Health Statistics over 2000-2016 period.Results: There were meaningful relationships from nurse staffing to life expectancy at birth and at 65 years with the long-run elasticities of 0.02 and 0.08,respectively.Overall,the role of nursing characteristics in increasing life expectancy indicators varied among different health care systems of OECD countries and in average were determined at the highest level in Japan (0.25),followed by Iceland (0.24),Belgium (0.21),Czech Republic (0.21),Slovenia (0.20) and Sweden (0.18).Conclusion: A higher proportion of nursing staff is associated with higher life expectancy in OECD countries and the dependency of life expectancy to nursing staff would increase by aging.Hence,the findings of this study warn health policy makers about ignoring the effects nursing shortages create e.g.increasing the risk of actual age-specific mortality,especially in care of elderly people.

新型冠状病毒疫情期间保持社交隔离的作用:基于北欧地区感染率、死亡率和医疗资源需求的证据

目的分析北欧国家社交隔离对减少新型冠状病毒感染肺炎(conmavims disease 2019,COVID-19)第一轮大流行期间患者的每日死亡率、感染率及医疗资源需求的影响。方法观察并分析社交隔离、每日死亡率、感染率及C0VID-19患者住院所需的医疗资源情况,所需医疗资源包括收治C0VID-19所需床位总数、ICU床位数和感染病房床位数及ICU和感染病房所需的护士人数。社交隔离通过手机移动量化数据与本底水平相比减少的程度进行衡量。数据来自美国华盛顿大学卫生计量与评价研究所(the Institute for Health Metrics and Evaluation,IHME),为丹麦、芬兰、冰岛、挪威和瑞典在第一轮大流行期间每10万人口的加权数据,时间跨度为40 d。采用面板数据分析方法,测评长吋间内社交隔离与C0VID-19相关指标之间的关系。结果动态长期模型的结果证实,采取社交隔离措施减少人群接触,与本底水平相比,每减少1%,每日死亡率、感染率、所需的医院床位总数、ICU床位数/护士人数以感染病房床位数/护士人数分别降低1.13%、15.26%、1.10%、1.17%和1.89%。此外,误差修正模型结果表明,这一系列平衡如果因社交隔离情况突然变化被破坏,h述系列指标重新恢M平衡所需吋间分別为67、62、40、22和49d。结论适当的社交隔离是北欧国家应对C0VID-19疫情的有效措施,可降低C0VID-19感染率、死亡率及医疗资源需求。此研究结果提醒备国政府,需要在使用疫苗预防感染、减轻医疗负担的同时,继续实行社交隔离政策。