Korean J Adult Nurs.  2019 Oct;31(5):479-486. 10.7475/kjan.2019.31.5.479.

Influence of Hospital Nurse Staffing Levels on the Colorectal Cancer Evaluation Grades, Mortality, and Length of Stay

• Kim Y
• Kim SY

• KMID: 2461063
• DOI: http://doi.org/10.7475/kjan.2019.31.5.479

Abstract

PURPOSE
In Korea, cancer is the leading cause of death, and colorectal cancer accounts for a third of deaths caused by cancer. This study aimed to analyze the influence of hospital nurse staffing level on colorectal cancer evaluation grades, mortality rate, and the length of stay of patients who underwent surgery for colorectal cancer.
METHODS
Secondary data collected in 2016, 2018 from the Health Insurance Review and Assessment Service, was used to measure nurse staffing, based on the adjusted nursing grade in general units and was then categorized as adhering with or violating the Medical Service Act. The influence of the nurse staffing on colorectal cancer evaluation grades, and the mortality rate in 129 hospitals was analyzed using multivariate logistic regression and multivariate gamma regression, respectively, and its influence on length of stay was analyzed through hierarchical multiple regression.
RESULTS
Hospitals that adhered to the Medical Service Act in nurse staffing had significantly lower odds for poor colorectal cancer evaluation grades. Hospitals which nurse staffing adhered to the Medical Service Act had a significantly lower mortality rate than those that violated it (B=−0.51, p=.019), and had a significantly shorter length of stay (β=−.19, p=.034).
CONCLUSION
Improvement of nurse staffing levels, in compliance with the Medical Service Act is crucial to provide high-quality nursing services to patients undergoing colorectal cancer surgery and to decrease the mortality rate, and shorten the hospitalization period required for surgery and recovery.

MeSH Terms

Cause of Death
Colonic Neoplasms
Colorectal Neoplasms*
Compliance
Hospitalization
Humans
Insurance, Health
Korea
Length of Stay*
Logistic Models
Mortality*
Nursing
Nursing Services

Reference

1. Marshall MN, Shekelle PG, Davies HTO, Smith PC. Public reporting on quality in the United States and the United Kingdom. Health Affairs. 2003; 22(3):134–148. DOI: 10.1377/hlthaff.22.3.134.

2. Lee KD. Efficient quality management by evaluating adequacy. HIRA Policy Trend. 2014; 8(4):71–85.

3. Health Insurance Review and Assessment Service. Find a hospital evaluation. [Internet]. Wonju: Health Insurance Review and Assessment Service;2018. cited 2018 October 1. Available from: https://www.hira.or.kr/re/diag/getDiagEvlList.do?pgmid=HIRAA030004000100.

4. Statistics Korea. 2017 Annual report on the causes of death statistics. Daejeon: Statistics Korea;2018. 10. Report No.: 11-1240000-000028-10.

5. Health Insurance Review and Assessment Service. 6th Quality evaluation report of colon cancer. Wonju: Health Insurance Review and Assessment Service;2018. 06.

6. Han KS, Khim SY, Lee SJ, Park ES, Park YJ, Kim JH, et al. Family functioning and quality of life of the family care-giver in cancer patients. Journal of Korean Academy of Nursing. 2006; 36(6):983–991. DOI: 10.4040/jkan.2006.36.6.983.

7. Moon KH, Ahn MJ, Kim PJ, Park JY, Kim MA, Park IS, et al. Analysis of nursing interventions frequently used with cancer patients. Journal of Korean Clinical Nursing Research. 2009; 15(1):107–122.

8. Lee HO. Empirical study: adjustment of persons with a permanent colostomy following stoma surgery [master's thesis]. Seoul: Ewha Womans University;1998.

9. Ju AR, Yeoum SG, Park KS. The nursing needs of post-surgical colon cancer patients at discharge. Journal of Korean Academy of Fundamentals of Nursing. 2009; 16(4):392–401.

10. Ball JE, Bruyneel L, Aiken LH, Sermeus W, Sloane DM, Rafferty AM, et al. Post-operative mortality, missed care and nurse staffing in nine countries: a cross-sectional study. International Journal of Nursing Studies. 2018; 78:10–15. DOI: 10.1016/j.ijnurstu.2017.08.004.

11. Kane RL, Shamliyan T, Mueller C, Duval S, Wilt TJ. Nurse staffing and quality of patient care. Evidence Report/Technology Assessment. Rockville, MD: Agency for Healthcare Research and Quality (US);2007. 03. Report No.: 07-E005.

12. Kim Y, Cho SH, June KJ, Shin SA, Kim J. Effects of hospital nurse staffing on in-hospital mortality, pneumonia, sepsis, and urinary tract infection in surgical patients. Journal of Korean Academy of Nursing. 2012; 42(5):719–729. DOI: 10.4040/jkan.2012.42.5.719.

13. George A, Adams Z, Majumder A, Martin G, Harder B, Dougherty GB. Methodology U.S. news & world report 2018–2019 best hospitals procedures & conditions ratings. U.S. News & World Report. Washington, DC: U.S. News & World Report, L.P.;2018. 08.

14. Kim Y, Kim SH, Ko Y. Effect of nurse staffing variation and hospital resource utilization. Nurs Health Sci. 2016; 18(4):473–480. DOI: 10.1111/nhs.12294.

15. Ministry of Health and Welfare. Korea Institute for Health and Social Affairs. OECD health statistics 2017(abstract). Seoul: Kyungsungmedia;2017. p. 3.

16. Kim YM, Kim , J , June KJ, Ham EO. Changing trend in grade of nursing management fee by hospital characteristics: 2008–2010. Journal of Korean Clinical Nursing Research. 2010; 16(3):99–109.

17. Paek SJ. Apply a penalty of 10% deduction of hospitalization fees for hospitals that do not report nursing staff. Dailymedi;2019. cited 2019 June 16. Available from: http://www.dailymedi.com/detail.php?number=843331&thread=22r01.

18. Cho SH. Nurse staffing and adverse patient outcomes [dissertation]. Ann Arbor, Michigan: University of Michigan;2002.

19. Statistics Korea. Number of hospital by the type: 2008–2016. [Internet]. Daejeon: Statistics Korea;2018. cited 2018 September 2. Available from: http://210.179.230.152:8083/statHtml/statHtml.do?orgId=358&tblId=DT_IEB002_4&conn_path=I2.

20. Health Insurance Review and Assessment Service. Find a hospital/pharmacy [Internet]. Wonju: Health Insurance Review and Assessment Service;2016. cited 2016 June 1. Available from: https://www.hira.or.kr/rd/hosp/getHospList.do?pgmid=HIRAA030002020000.

21. Shin YS, Hwang DK, Kim SU, Park GR. Research on improvement plan of differentiated inpatient nursing fees according to the level of nursing manpower staffing. Sejong: Korea Institute for Health and Social Affairs;2015. 12. Report No.: G000CU1-2015-200.

22. Lee IH. Easy flow regression analysis. Seoul: Hannarae;2014. p. 434–443.

23. Aiken LH. The California nurse staffing mandate: implications for other states. LDI Issue Brief. 2010; 15(4):1–4.

24. Cho SH, Kim YS, Yeon KN, You SJ, Lee ID. Effects of increasing nurse staffing on missed nursing care. International Nursing Review. 2015; 62(2):267–274. DOI: 10.1111/inr.12173.

25. Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K. Nurse-staffing levels and the quality of care in hospitals. The New England Journal of Medicine. 2002; 346(22):1715–1722. DOI: 10.1056/nejmsa012247.

26. Tschannen D, Kalisch BJ. The effect of variations in nurse staffing on patient length of stay in the acute care setting. Western Journal of Nursing Research. 2008; 31(2):153–170. DOI: 10.1177/0193945908321701.

27. Hae SH. Nursing workforce issues and improvement strategies in Korea. Oral presented at: The Policy forum of guarantee national health rights and improve quality of nursing. . Seoul: 2019. 06. 12.

28. Kim Y, Kim J, Shin SA. Relationship between the legal nurse staffing standard and patient survival after perioperative cardiac arrest: a cross-sectional analysis of Korean administrative data. International Journal of Nursing Studies. 2019; 89:104–111. DOI: 10.1016/j.ijnurstu.2018.09.012.