Association between Nurse Staffing and Mortality in Patients with Ischemic and Hemorrhagic Stroke in the Intensive Care Units

Purpose: This study examined the association between nurse staffing and in-hospital 30-day mortality among stroke patients considering the stroke type in the intensive care units in Korea using the Health Insurance Review and Assessment Service-National Inpatient Sample 2018 (HIRA-NIS 2018). Methods: The data included a total of 2,876 stroke patients admitted to intensive care units across 72 general hospitals and 39 tertiary hospitals between January and November 2018. Nurse staffing levels were measured using the nurse staffing grades of adult intensive care units in the 2nd quarter of 2018. The relationship between nurse staffing levels and mortality were analyzed using multi-level logistic regression analysis after controlling for patient and hospital characteristics. Results: In patients with ischemic stroke, the risk of death was lower in nurse staffing Grade 5 to 6 compared to Grade 1 (Odds ratio [OR] 0.43, 95% Confidence interval [CI] 0.24~0.75). In hemorrhagic stroke patients, the risk of death tended to be higher in nurse staffing grade 5 to 6 compared to Grade 1 (OR 2.11, 95% CI 1.00~4.45), which was marginally significant (p=.050). Conclusion: Health policies for adequate nurse staffing in intensive care units should be implemented to enhance the quality of care and lead to better outcomes in patients with stroke.