Intensive care 1980–1995: change in patient characteristics, nursing workload and outcome

Abstract

Objective: To assess temporal changes in patient characteristics, nursing workload and outcome of the patients and to compare the actual amount of available nursing staff with the estimated needs in a medical-surgical ICU. Design: Retrospective analysis of prospectively collected data. Setting: A medical-surgical adult intensive care unit (ICU) in a Swiss university hospital. Patients: Data of all patients staying in the ICU between January 1980 and December 1995 were included. Interventions: None. Measurements and results:The estimated number of nurses needed was defined according to the Swiss Society of Intensive Care Medicine (SGI) grading system: category I = one nurse/patient/shift ( = 8 h), category II = one nurse/two patients/shift, category III= one nurse/ three patients/shift. An intervention score (IS) was obtained, based on a number of specific activities in the ICU. There was a total of 35,327 patients (32 % medical and 68 % postoperative/trauma patients). Over time, the number of patients per year increased (1980/1995: 1,825/2,305, p < 0.001) and the length of ICU stay (LOS) decreased (4.1/3.8 days, p < 0.013). There was an increase in the number of patients aged > 70 years (19 %/28 %, p < 0.001), and a decrease in the number of patients < 60 years (58 %/41%, p < 0.001). During the same time period, the IS increased two-fold. Measurement of nursing workload showed an increase over time. The number of nursing days per year increased (1980/1995: 7454/8681, p < 0.019), as did the relative amount of patients in category I (49 %/71%,p < 0.001), whereas the portion of patients in category II (41%/28 %, p < 0.019) and category III (10 %/0 %) decreased. During the same time period, mortality at ICU discharge decreased (9.0 %/ 7.0 %, p < 0.002). Conclusions: During the last 16 years, there has been a marked increase in workload at this medicalsurgical ICU. Despite an increase in the number of severely sick patients (as defined by the nursing grading system) and patient age, ICU mortality and LOS declined from 1980 to 1995. This may be ascribed to improved patient treatment or care. Whether an increasingly liberal discharge policy (transfer to newly opened intermediate care units, transfer of patients expected to die to the ward) or a more rigorous triage (denying admission to patients with a very poor prognosis) are confounding factors cannot be answered by this investigation. The present data provide support for the tenet that there is a trend toward more complex therapies in increasingly older patients in tertiary 1166 care ICUs. Calculations for the number or nurses needed in an ICU should take into account the increased turnover of patients and the changing patient characteristics.

Carga de trabalho de enfermagem requerida por adultos, idosos e muito idosos em Unidade de Terapia Intensiva

“…A study carried out in Switzerland confirmed this premise in a comparative analysis of 35.327 ICU patients' characteristics, hospitalized between 1980 and 1995, showing a significant increase in patients' age during that period (1) .…”

“…Researches appoint that specialized nursing workforce is one of the main sources of resource consumption in these environments, explaining the need for adequate staff dimensioning (1)(2)(3)(4) . In this context, one of the challenges ICU managers face is to adapt the nursing staff to the care demands of severe patients, which includes an increasingly large contingent of elderly and elder elderly patients, due to global population aging.…”

Occupational stress, job satisfaction, and working environment among Icelandic nurses: A cross-sectional questionnaire survey

“…These stressful conditions are universal and researchers in various parts of the world, e.g. Australia (Tarnow-Mordi et al, 2000), Belgium (Stordeur et al, 2001), Great Britain (McGowan, 2001Payne, 2001), Greece (Alexopoulos et al, 2003), Ireland (Wynne et al, 1993), Switzerland (Jakob and Rothen, 1997), Taiwan (Lee and Wang, 2002) and in the US (Santos et al, 2003) have shown that nurses have to cope with a strenuous workload and occupational stress. There are no published studies of stress and workload among Icelandic nurses, who are the subjects of this study, so it is important to find out if they experience occupational stress in ways similar to nurses in other countries.…”

Fatores associados à carga de trabalho de enfermagem em Unidade de Terapia Intensiva

“…Nas UTI(s), reconhecidas pela elevada carga, (que representa um fator de alto custo), e pelo elevado índice de mortalidade, (medida que expressa produção/rendimento) (3) , durante décadas utilizou-se a razão mortalidade/morbidade como parâmetro de escolha para descrever resultado da eficiência do cuidado intensivo. Todavia, nos últimos anos, a inclusão da demanda de trabalho de enfermagem como um parâmetro para avaliação dos resultados, tem sido também considerada, devido ao seu impacto na qualidade da assistência intensiva (3) .…”