Nursing Care Dependency as Measured with the INICIARE Scale as a Predictor of In-Hospital Mortality: A Prospective Observational Study

Abstract

Background: In-hospital mortality is a key indicator of the quality of care. Studies estimate in-hospital mortality to be around 5%. Studies so far have demonstrated the influence of individual, clinical, and hospital-related factors on in-hospital mortality. Currently, new variables, such as nursing workload or the level of dependency, are being incorporated into these models. We aimed to explore the independent predictive power of the INICIARE scale regarding in-hospital mortality while controlling for individual, clinical, and hospital-related factors. Methods: An observational prospective design was used. Sampling was conducted between February 2015 and October 2017. The necessary sample size was calculated based on the prevalence of in-hospital mortality. Patients over 16 years, admitted to medical or surgical units at 11 public hospitals in Andalusia (Spain), with a foreseeable stay of at least 48 hours were included. Multivariate regression analyses were performed to assess the data. Findings: The sample consisted of 3821 assessments conducted in 1004 patients. The mean profile was that of a male (52%), with a mean age of 64.5 years old, admitted to a medical unit (56.5%), with an informal caregiver (60%). In-hospital mortality was 4%. The INICIARE scale yielded an odds ratio of 0.987 (95% confidence interval: 0.97-0.99) and the nurse staffing level yielded an odds ratio of 1.197 (95% confidence interval: 1.02-1.4). Interpretation: INICIARE has been shown to have an independent predictive power regarding in-hospital mortality. Funding Statement: Regional Ministry of Health of Andalusia Declaration of Interests: Authors declare no conflict of interest. Ethics Approval Statement: The ethics committee of the Andalusian Healthcare System approved the project (CPMP/ICH/135/95). Participants signed an informed consent form.