Relationship between the legal nurse staffing standard and patient survival after perioperative cardiac arrest: A cross-sectional analysis of Korean administrative data

Abstract

Background: Nurses play crucial roles in cardiopulmonary resuscitation after perioperative cardiac arrest (PCA), and the level of nurse staffing is thought to influence the survival rate for cardiac arrest. However, no previous study has investigated the survival rate after PCA in Korea. In addition, nurse staffing levels in Korea are relatively low and their legal standard is not widely followed.

Objectives: This study investigated the relationships between nurse staffing level and survival after PCA in Korean hospitals using inpatient National Health Insurance (NHI) claim data.

Methods: The study used NHI claim data on patient and hospital characteristics for 2140 patients undergoing craniotomy or percutaneous angioplasty from January to December 2009. Because the information about nurse staffing in NHI claim data categorized nursing grade according to the nurse-to-bed ratio, the nurse staffing level was transformed from the nurse-to-patient ratio using the bed occupancy rate. The general ward and ICU nurse staffing levels were then categorized into major violation, violation, adherence, and major adherence according to the medical law standard. The association between nurse staffing level and survival after PCA was analyzed using logistic regression analyses with a generalized estimation model.

Results: The survival rate was higher for patients in hospitals with major adherence [odds ratio (OR) = 1.53, 95% confidence interval (CI) = 1.13-2.07] ICUs nurse staffing than for those in hospitals with adherence nurse staffing, and lower for patients in hospitals with violation (OR = 0.50, 95% CI = 0.26-0.93) or major violation (OR = 0.45, 95% CI = 0.21-0.97) general ward nurse staffing than for those in hospitals with adherence nurse staffing. Policies to ensure adherence to the medical law standard for nurse staffing levels is necessary to enhance the safety of patients experiencing PCA in Korea.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Nursing; Perioperative period; Personnel staffing; Survival.