Patient Mortality Is Associated With Staff Resources and Workload in the ICU: A Multicenter Observational Study (original) (raw)
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Nurse Staffing and Patient Mortality in Intensive Care Units
Nursing Research, 2008
Background: Research evidence suggests that nurse staffing influences patient outcomes. b Objectives: To examine the relationship between nurse staffing and patient mortality in Korean intensive care units (ICUs). b Methods: Using survey and administrative databases, this study included 27,372 ICU patients discharged from 42 tertiary and 194 secondary hospitals. Ownership (public vs. private), location (metropolitan city vs. province), size, specialization of ICUs (specialized vs. mixed), physician staffing and nurse staffing, and years of nurse experience were included as hospital and ICU characteristics. Nurse staffing was measured as the ratio of average daily census to the total number of full-time equivalent registered nurses in ICUs. Age, gender, 26 categories of primary diagnoses, 16 groups of comorbid conditions, and source of payment were used for risk adjustment. Mortality was defined as deaths that occurred in the hospital or on the date of hospital discharge. Using SAS GLIMMIX procedures, multivariate logistic regression analysis was employed separately for tertiary and secondary hospitals. b Results: In tertiary hospitals, a greater likelihood of dying was 322
Nurse staffing, medical staffing and mortality in Intensive Care: An observational study
International journal of nursing studies, 2014
To investigate whether the size of the workforce (nurses, doctors and support staff) has an impact on the survival chances of critically ill patients both in the intensive care unit (ICU) and in the hospital. Investigations of intensive care outcomes suggest that some of the variation in patient survival rates might be related to staffing levels and workload, but the evidence is still equivocal. Information about patients, including the outcome of care (whether the patient lived or died) came from the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme. An Audit Commission survey of ICUs conducted in 1998 gave information about staffing levels. The merged dataset had information on 65 ICUs and 38,168 patients. This is currently the best available dataset for testing the relationship between staffing and outcomes in UK ICUs. A cross-sectional, retrospective, risk adjusted observational study. Multivariable, multilevel logistic regression. ICU and in-hospital m...
Association of Intensive Care Unit Patient-to-Intensivist Ratios With Hospital Mortality
JAMA internal medicine, 2017
The patient-to-intensivist ratio (PIR) across intensive care units (ICUs) is not standardized and the association of PIR with patient outcome is not well established. Understanding the impact of PIR on outcomes is necessary to optimize senior medical staffing and deliver high-quality care. To test the hypotheses that: (1) there is significant variation in the PIR across ICUs and (2) higher PIRs are associated with higher hospital mortality for ICU patients. Retrospective cohort analysis of patients (≥16 years) admitted to ICUs staffed by a single intensivist during daytime hours in the United Kingdom from 2010 to 2013. Patient-to-intensivist ratios, which we defined for each patient as the number of patients cared for by the intensivist each day averaged over the patient's stay. Using standard summary statistics, we evaluated PIR variation across ICUs. We used multivariable, mixed-effect, logistic regression analysis to evaluate the association between PIR and hospital mortality...
Nursing protects, promotes and optimizes health and capacity, prevents illness and injury, promotes healing, diagnoses and treats human responses to alleviate suffering, and advocates for the care of individuals, families, groups, communities and the communities. One of the most often studied aspects among the quality patient care are nursing workload, nurse patient ratio, nurse's availability in the intensive care unit, which directly has an impact on the efficacy of quality patient care. The purpose of this study is to assess the Nurse Patient Ratio as per the statutory requirements. To advocate the availability of Nursing Staff in the ICU's. To study the workload of all the staff nurses in the ICU's & calculating nursing staff requirements' Descriptive research is used. It is carried out in SICU, MICU, CCU and ITU. The number of patients in the observational study was 206 and the number of nurses was 24. Data collection is carried on needed legal requirements. Data were tabulated and percentile score were calculated. Results demonstrated the need for refining of stature patient-nurse ratio, nursing workload and nursing availability in ICU. The study was useful in drawing out the limitations which would pave a way for improved planning.
Variations in Mortality and Length of Stay in Intensive Care Units
Annals of Internal Medicine, 1993
Objective: To evaluate the amount of variation in in-hospital mortality and length of intensive care unit (ICU) stay that can be accounted for by clinical data available at ICU admission. Design: Inception cohort study. Setting: Forty-two ICUs in 40 hospitals, including 26 hospitals that were randomly selected and 14 large tertiary care hospitals that volunteered for the study. Participants: A consecutive sample of 16 622 patients and 17 440 ICU admissions. Measurements and Main Outcomes: Data on selected demographic characteristics, comorbidity, and specific physiologic variables were recorded during the first ICU day for an average of 415 admissions at each ICU; hospital discharge status (dead or alive) and length of ICU stay were recorded for individual patients; and the ratio of actual to predicted in-hospital mortality, standardized mortality ratios, and the ratio of actual to predicted length of ICU stay were recorded for individual ICUs. Results: Unadjusted in-hospital mortality rates for the 42 units varied from 6.4% to 40%, and 90% (R 2 = 0.90) of this variation was attributable to patient characteristics at admission. The standard mortality ratio varied from 0.67 to 1.25. The mean unadjusted length of ICU stay varied from 3.3 to 7.3 days, and 78% of the variation (R 2 = 0.78) was attributed to patient and selected institutional characteristics. The best performing unit had a length of stay ratio of 0.88, whereas the poorest performing unit had a ratio of 1.21. Conclusions: Clinicians can use readily available admission data to adjust for considerable variations in patient severity and type in different ICUs. Such data should permit precise evaluation and comparison of ICU effectiveness and efficiency, which varied substantially in this study, and result in improved methods of risk prediction and evaluation of new medical practices. Intensive care units (ICUs), first introduced in the 1960s, now account for approximately 7% of total U.S. hospital beds, 20% to 30% of hospital costs, and 1% of the U.S. gross domestic product [1,2,3]. These economic and institutional consequences have increased the need for outcome evaluation and guidance regarding efficient utilization. Mortality rates, an insensitive measure for an entire hospital [4,5,6], are high enough in ICUs to serve as one reliable performance indicator. Substantial progress has also been made in identifying clinical risk factors for death and resource utilization for patients in ICUs [7,8,9,10,11]. The objective of this study was to explore the ability to evaluate ICU performance using risk-adjusted in-hospital mortality rates and length of ICU stay. In this report, we focus on the amount of variation that can be accounted for after adjusting for patient characteristics present at admission. We describe the nature and relative importance of these factors and the extent of the remaining variation in outcome performance after such adjustment.
Higher ICU Capacity Strain Is Associated With Increased Acute Mortality in Closed ICUs*
Critical Care Medicine, 2020
Objectives: To determine whether patients admitted to an ICU during times of strain, when compared with its own norm (i.e. accommodating a greater number of patients, higher acuity of illness, or frequent turnover), is associated with a higher risk of death in ICUs with closed models of intensivist staffing. Design: We conducted a large, multicenter, observational cohort study. Multilevel mixed effects logistic regression was used to examine relationships for three measures of ICU strain (bed census, severity-weighted bed census, and activity-weighted bed census) on the day of admission with risk-adjusted acute hospital mortality. Setting: Pooled case mix and outcome database of adult general ICUs participating in the Intensive Care National Audit and Research Centre Case Mix Programme. Measurements and Main Results: The analysis included 149,310 patients admitted to 215 adult general ICUs in 213 hospitals in United Kingdom, Wales, and Northern Ireland. A relative lower strain in ICU capacity as measured by bed census on the calendar day (daytime hours) of admission was associated with decreased risk-adjusted acute hospital mortality (odds ratio, 0.94; 95% CI, 0.90-0.99; p = 0.01), whereas a nonsignificant association was seen between higher strain and increased acute hospital mortality (odds ratio, 1.04; 95% CI, 1.00-1.10; p = 0.07). The relationship between periods of high ICU strain and acute hospital mortality was strongest when bed census was composed of higher acuity patients (odds ratio, 1.05; 95% CI, 1.01-1.10; p = 0.03). No relationship was seen between high strain and ICU mortality. Conclusions: In closed staffing models of care, variations in bed census within individual ICUs was associated with patient's predicted risk of acute hospital mortality, particularly when its standardized bed census consisted of sicker patients.
Measuring the nursing workload per shift in the ICU
Intensive Care Medicine, 2012
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Journal of Advanced Nursing, 2006
Journal of Advanced Nursing 55(4), 435-448 Nurse staffing levels and hospital mortality in critical care settings: literature review and meta-analysis Aim. This paper reports a review of the literature on the association between critical care nurse staffing levels and patient mortality. Background. Statistically significant inverse associations between levels of nurse staffing and hospital mortality have not been consistently found in the literature. Critical care settings are ideal to address this relationship due to high patient acuity and mortality, high intensity of the nursing care required, and availability of individual risk adjustment methods. Methods. Major electronic databases were searched, including MEDLINE, EMBASE, and the Cumulative Index of Nursing and Allied Health Literature.