Patient Mortality Is Associated With Staff Resources and Workload in the ICU

Neuraz, Antoine; Guérin, Claude; Payet, Cécile; Polazzi, Stéphanie; Aubrun, Frédéric; Dailler, Frédéric; Lehot, Jean‐Jacques; Piriou, Vincent; Neidecker, J.; Rimmelé, Thomas; Schott, Anne-Marie; Duclos, Antoine

doi:10.1097/ccm.0000000000001015

Cited by 238 publications

(198 citation statements)

References 30 publications

(30 reference statements)

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“…YBÜ'de izlenen kritik hastalarda monitörizasyon, ilaç uygulamaları ve girişimler nitelik ve niceliksel olarak oldukça fazladır ve tüm bu nedenlerden dolayı verilmekte olan hemşirelik hizmeti sağ kalımı doğrudan etkileyebilmektedir (1,2). Ayrıca maliyetler göz önüne alındığında kaynakların etkin olarak kullanılması amacı ile YBÜ'de izlenmesi gereken hastaların tanımlanması, hasta gruplarına ve hastalık şiddetlerine paralel olarak oluşacak hemşire iş yükünün belirlenmesi ve ünitenin organizasyonundaki planlamalarının bu değerlendirmeler ışığında yapılması gereklidir.…”

Section: Introductionunclassified

The Relationship between Nurse Workload and Mortality in Two Different ICUs

Ergan¹,

Tokur²,

Coban³

et al. 2016

Yoğun Bakim Derg

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Section: Introductionunclassified

The Relationship between Nurse Workload and Mortality in Two Different ICUs

Ergan¹,

Tokur²,

Coban³

et al. 2016

Yoğun Bakim Derg

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“…In this sample, the extremes are represented by ICUs in the United Kingdom, where 97% reported a 1:1 nurse/patient ratio, in contrast to French ICUs, with 90% reporting 1:3 or higher nurse/patient ratios (including 66% with a ratio of 1:4). Many studies have shown that heavier nursing workloads are associated with poor patient outcomes (29). Specifically, one meta-analysis of 90 studies found that increased registered nurse staffing was associated with lower mortality in intensive care, medical, and surgical units; reduced risk of hospital-acquired pneumonia, unplanned extubation, respiratory failure, cardiac arrest, and failure to rescue; and shorter lengths of stay for both surgical and ICU patients (30).…”

Section: Original Researchmentioning

confidence: 99%

Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. An International Survey

Bakhru¹,

et al. 2016

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Rationale: Early mobilization (EM) improves outcomes for mechanically ventilated patients. Variation in structure and organizational characteristics may affect implementation of EM practices.Objectives: We queried intensive care unit (ICU) environment and standardized ICU practices to evaluate organizational characteristics that enable EM practice. Methods:We recruited 151 ICUs in France, 150 in Germany, 150 in the United Kingdom, and 500 in the United States by telephone. Survey domains included respondent characteristics, hospital and ICU characteristics, and ICU practices and protocols. Measurements and Main Results:We surveyed 1,484 ICU leaders and received a 64% response rate (951 ICUs). Eighty-eight percent of respondents were in nursing leadership roles; the remainder were physiotherapists. Surveyed ICUs were predominantly mixed medicalsurgical units (67%), and 27% were medical ICUs. ICU staffing models differed significantly (P , 0.001 each) by country for high-intensity staffing, nurse/patient ratios, and dedicated physiotherapists. ICU practices differed by country, with EM practices present in 40% of French ICUs, 59% of German ICUs, 52% of U.K. ICUs, and 45% of U.S. ICUs. Formal written EM protocols were present in 24%, 30%, 20%, and 30%, respectively, of those countries' ICUs. In multivariate analysis, EM practice was associated with multidisciplinary rounds (odds ratio [OR], 1.77; P = 0.001), setting daily goals for patients (OR, 1.62; P = 0.02), presence of a dedicated physiotherapist (OR, 2.48; P , 0.001), and the ICU's being located in Germany (reference, United States; OR, 2.84; P , 0.001). EM practice was also associated with higher nurse staffing levels (1:1 nurse/patient ratio as a reference; 1:2 nurse/patient ratio OR, 0.59; P = 0.05; 1:3 nurse/patient ratio OR, 0.33; P = 0.005; 1:4 or less nurse/patient ratio OR, 0.37; P = 0.005). Those responding rarely cited ambulation of mechanically ventilated patients, use of a bedside cycle, or neuromuscular electrical stimulation as part of their EM practice. Physical therapy initiation, barriers to EM practice, and EM equipment were highly variable among respondents. Conclusions:International ICU structure and practice is quite heterogeneous, and several factors (multidisciplinary rounds, setting daily goals for patients, presence of a dedicated physiotherapist, country, and nurse/patient staffing ratio) are significantly associated with the practice of EM. Practice and barriers may be far different based upon staffing structure. To achieve successful implementation, whether through trials or quality improvement, ICU staffing and practice patterns must be taken into account.

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“…8 Reinforcing the rationale for identifying and studying staff dimensioning, it is known that, at the international level, the high workload of the nursing team -commonly associated with the quantitative deficit of professionals -can directly compromise the care quality. It can contribute, for example, to a higher risk of death with the reduction of the proportion of nurses per patient, 9 increased rates of adverse events, such as pressure injuries, falls, errors in drug administration 10 and hospital infections, and increased length of hospitalization.…”

mentioning

confidence: 99%