Nurse understaffing is associated with adverse events in postanaesthesia care unit patients

Abstract

Aims and objectivesTo investigate the associations between nurse staffing and the incidence and severity of hypoxaemia, arterial hypotension and bradycardia of postoperative patients during their postanaesthesia care unit stay.BackgroundNurse understaffing has been associated with adverse patient outcomes in a variety of hospital settings. In the postanaesthesia care unit, nursing shortage is common and can be related to compromised prevention, detection and treatment of adverse events.DesignObservational, single‐centre, prospective study that adhered to Strengthening the Reporting of Observational studies in Epidemiology checklist (see Supporting information Appendix S1); 2,207 patients admitted to the postanaesthesia care unit of a tertiary care hospital over a 5‐month period were enrolled.MethodsIncidence of hypoxaemia (arterial oxygen saturation <95%), arterial hypotension (systolic blood pressure <90 mmHg) and bradycardia (heart rate <50 beats per minute), along with episode severity, was recorded. Patients were classified into three groups as follows: sufficient staffing, low and high understaffing. Risk for hypoxaemia, arterial hypotension and bradycardia was adjusted according to patient, anaesthesia and operation characteristics.ResultsThe incidence of hypoxaemia was significantly higher in the high understaffing group patients, while the incidence of arterial hypotension was significantly higher in both low and high understaffing group patients, compared to sufficient staffing group ones. In the high understaffing group patients, hypoxaemia and arterial hypotension episodes were of significantly higher severity.ConclusionsThese associations between hypoxaemia and arterial hypotension and postanaesthesia care unit understaffing indicate that care quality and patient safety can be compromised in case patient acuity is not matched with sufficient nursing resources.Relevance to clinical practiceHigher incidence of hypoxaemia and arterial hypotension advocates for the prevention of imbalances between patient number and care demands and the number of available nurses.

Efficacy of High-Quality Nursing Service for the Patients during the Anesthesia Recovery Period: A Meta-Analysis

“…The characteristics of included studies are summarized in Table 1. Eight involving high-quality nursing services for the patients during the anesthesia recovery period were included [10][11][12][13][14][15][16][17]. All the experimental groups were treated with high-quality nursing [10][11][12][13][14][15][16][17].…”

“…Meta-analysis identifies the risk of bias in randomized trials included in this study (Figure 2). We performed the randomization based on the computer-aided random list or using a randomly generated pattern of numbers within most of the trials [10][11][12][13][14][15][16][17]. The low risk of incomplete outcome data and selection of outcome reports were utilized to characterize the randomized trials taken in this research.…”

The Elephant in the Room: Nurses’ Views of Communication Failure and Recommendations for Improvement in Perioperative Care

“…Apker et al determined that inadequate staffing caused setbacks in verbal communication, which threatened patient safety. It is repeatedly pointed out in the literature that staffing deficits and excessive workload pose a risk to patient safety and are generally identified as systemic problems …”

Evaluation of Complication Development in General Surgery Patients Admitted to the Post Anesthesia Care Unit

“…The amyloid cascade hypothesis 1 suggests that the consequent accumulation of Aβ peptides mediates the pathogenesis of AD through synaptic injury, gliosis, and NFTs. Amyloid beta loads are associated positively with clinical cognitive severity and faster cognitive decline in people with subjective memory impairment (SMI), 2 mild cognitive impairment (MCI), 3 and early AD. 4 Mild cognitive impairment patients with amyloid-positive deposition have a significantly greater risk of progression to dementia compared with people with amyloid-negative deposition, 5 and faster converters have higher Aβ load than slower converters.…”

“…Surgery and anesthesia always carry potential for the development of complications. In this critical period, when post-operative complications and mortality rates are the highest, factors such as having a limited patient follow-up period, complex patient care, emergency administrations of medications, and monitoring of the patient by multiple teams affect patient safety and increase the risk of complications (1)(2)(3).…”