| [Objective] Grasp the problems that exist on resource allocation in Beijing tertiary hospital. Analysis the influencing factors of emergency nursing human resourse allocation. Build up a dynamic emergency nursing manpower forecasting model based on the requirement of the patients.[Method] Using sampling by purpose sampling cross-sectional survey to investgate the present situation and problems of nursing manpower in the top three hospitals in Beijing. By the method of expert consultation, determination of working hours, to annlysis the emergency nursing hour by classification of category, class and item. Using prospective study to analysis the factors that influence nursing work hours. Single factor linear regression, multiple linear regression. Using pearson or spearman to do the correlation analysis to invesgate the nursing man-hour and scoring system. Scoring system for patients'outcome the predictive value of using ROC curve analysis. Multifactor regression equations and improved NEWS score rating equation back generations respectively. All the factors do matching test and linear correlation analysis with actual nursing man-hour respectively.Establish a predictive model of emergency nursing manpower allocation based on improved NEWS score.[Result]1 There is not a unified standard in emergency nurses. Personnel shortage and waste coexist. Nursing stuff age under 30 accounts for 54.87%, the primary titles accounted for 86.36%, less than 5 years working years accounted for 49.01%, below college degree account for 68.4%.2 Among the total working hours, direct working hours acccount for 71.06%, in direct nursing working hours account forl1.58%, personal activity time accounted for 17.36%, day time shift accounted for 50.95% of the general, late shift (28. 29%), night shift (20.76%). There isn't existing a correlation between the amount of working hours and emergency volume.3 Using single factor analysis the factors that influcence nursing hours, the factors includes age, tracheal tube, Stomach tube, central venous catheter, respiratory support, breathing rate, heart rate, blood oxygen saturation, blood glucose, electrocardiogram (ecg), voiding dysfunction, difficulty breathing, oxygen, catheters, activity ability, pressure ulcers. The influence factors of multiple regression analysis were:activity, heart rate, age, voiding dysfunction, blood oxygen saturation, oxygen, central venous catheter; Nursing man-hour and NEWS scores, REMS grade, SCS and APACHE ? scores, improved NEWS scores were positively correlated. Nursing man-hour and ADL scores, Mainz emergency scores, and GCS scores were negatively correlated Multifactor regression equations and improved NEWS rating equation are predictable nursing man-hour, improved NEWS ratings equation is better than that of multivariate regression equation. In clinical practice,it is valuable to establish a predictive model of emergency nursing manpower allocation based on improved NEWS score.4. Using scoring system to predict patient outcome of values:from the area und er the curve (AUC) in the value of predicting patient outcome, APACHEII> SC S scores> improved NEWS score; We use Youden index to judge the value of screening, SCS score> APACHEII> REMS score. Improved NEWS score AUC area is 0.844 and Youden index was 0.445 which was higher than NEWS ratin gs.[Conclusion]Beijing tertiary hospital emergency nursing manpower busy uneven idle, the structure is unreasonable,Nursing workload has nothing to do with emergency volume.Nursing hour is related to the patient's condition. Nursing manpower allocation model based on improved NEWS score to measure the nursing working hours can meet the practical requirement of patients and allocate nurses dynamically. So it is a scientific, effective and convenient emergency nursing manpower allocation model. |
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