Volume of activity and occupancy rate in intensive care units. Association with mortality

lapichino, Gaetano; Gattinoni, Luciano; Radrizzani, D.; Simini, Bruno; Bertolini, Guido; Ferla, Luca; Mistraletti, Giovanni; Porta, Francesca; Miranda, Dinis Reis

doi:10.1007/s00134-003-2113-4

Cited by 102 publications

(96 citation statements)

References 22 publications

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“…In this study, demographics and clinical findings were similar to previously published articles in the ICU and PICU field [28][29][30][31][32]. The mortality rates in the MICU and SICU are comparable to those in other studies [28,29].…”

Section: Discussionsupporting

confidence: 89%

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Measuring the nursing workload per shift in the ICU

et al. 2012

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Purpose: In the intensive care unit (ICU) different strategies and workload measurement tools exist to indicate the number of nurses needed. The gathered information is always focused on manpower needed per 24 h. However, a day consists of several shifts, which may be unequal in nursing workload. The aim of this study was to evaluate if differences in nursing workload between consecutive shifts can be identified by a nursing workload measurement tool. Methods: The nursing activities score (NAS) was registered per patient for every shift during a 4-week period in a prospective, observational research project in the surgical-pediatric ICU (SICU-PICU) and medical ICU (MICU) of an academic hospital. Results: The NAS was influenced by the patient characteristics and the type of shift. Furthermore, the scores were lower during night shifts, in weekends and in MICU patients. Overall, the mean NAS per nurse per shift was 85.5 %, and the NAS per 24 h was 54.7 %. Conclusion: This study has shown that the nursing workload can be measured per working shift. In the ICU, the NAS differentiates the nursing workload between shifts, patients and units.

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Section: Discussionsupporting

confidence: 89%

“…The mortality rates in the MICU and SICU are comparable to those in other studies [28,29]. The severity of illness scores are in line with those in the literature [28,30,33].…”

Section: Discussionsupporting

confidence: 88%

Measuring the nursing workload per shift in the ICU

et al. 2012

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“…In a general sample from the Austrian database variation in mortality was present even after adjustment for severity of illness, and this was explained at least in part by differences in case mix and standards of care [8]. Further factors relevant for such variation in outcome may include pre-ICU care, ICU staff workload [9], occupancy rate and volume of activity [10][11][12], and variations in post-ICU standards of care. Whether other factors, such as organizational characteristics of the hospital and ICU, type and size of the ICU, and variables related to physician staffing, are associated with variability in resource use and outcome has not been studied extensively.…”

Section: Introductionmentioning

confidence: 99%

Variability in outcome and resource use in intensive care units

et al. 2007

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“…Esses resultados confirmam os achados de vários estudos que sugerem que uma carga excessiva de trabalho é um fator de risco para desfechos indesejáveis em UTINs e unidades de terapia intensiva para adultos [4][5][6]22 . Em países em desenvolvimento, muitos desfechos indesejáveis são precedidos por eventos adversos inesperados, tais como extubação acidental, obstrução do tubo endotraqueal e desconexão do circuito do ventilador.…”

Section: Discussionunclassified

“…Desde a década de 1980, vários estudos têm investigado a relação entre carga excessiva de trabalho e a ocorrência de resultados neonatais adversos [1][2][3][4][5] . Muitos desses estudos investigaram a associação entre carga de trabalho em unidades de terapia intensiva neonatal (UTINs) e a ocorrência de eventos clínicos adversos, por exemplo, sepse, sequelas neurológicas e óbito [6][7][8][9][10][11] .…”

Section: Introductionunclassified

Staff workload and adverse events during mechanical ventilation in neonatal intensive care units

et al. 2011

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Objective: To investigate a possible association between the intensity of staff workload and intermediate adverse events, such as accidental extubation, obstruction of the endotracheal tube, and accidental disconnection of the ventilator circuit, during neonatal mechanical ventilation in high-risk neonatal units. Method:This prospective cohort study analyzed data of 543 newborns from public neonatal intensive care units (NICUs) in the city of São Luís, state of Maranhão, Northeastern Brazil, for 6 months, during which 136 newborns were submitted to mechanical ventilation in 1,108 shifts and were observed a total of 4,554 times. ResumoObjetivo: Investigar uma possível associação entre a carga de trabalho de profissionais da saúde e eventos adversos intermediários, tais como extubação acidental, obstrução do tubo endotraqueal e desconexão acidental do circuito do ventilador, durante ventilação mecânica neonatal em unidades neonatais de alto risco.Método: Este estudo de coorte prospectiva analisou os dados referentes a 543 recém-nascidos de unidades de terapia intensiva neonatal (UTINs) de São Luís (MA) por 6 meses, durante os quais 136 recém-nascidos foram submetidos a ventilação mecânica em 1.108 turnos e foram observados 4.554 vezes. Resultados:Ocorreram eventos adversos 117 vezes durante esse período. As associações entre carga de trabalho e eventos adversos foram analisadas por meio de equações de estimação generalizada. As variáveis de ajuste foram: peso de nascimento, gênero, maternidade estudada, pontuação no índice de risco clínico para bebês (clinical risk index for babies) e demanda de cuidados, determinada pela escala desenvolvida pela Northern Neonatal Network. Quanto maior o número de recém-nascidos classificados de acordo com a demanda de cuidados (RCDCs) por enfermeiro e técnico em enfermagem, maior a probabilidade da ocorrência de eventos adversos intermediários relacionados à ventilação mecânica. Um número de RCDCs > 22 por enfermeiro [risco relativo (RR) = 2,86] e > 4,8 por enfermeiro auxiliar (RR = 3,41) esteve associado a uma maior prevalência de eventos adversos intermediários. Conclusões:A carga de trabalho dos profissionais de UTINs parece interferir nos resultados intermediários do cuidado neonatal e, portanto, deve ser levada em conta na avaliação dos desfechos na UTIN.J Pediatr (Rio J). 2011;87(6)

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Volume of activity and occupancy rate in intensive care units. Association with mortality

Abstract: Intensive care patients, whatever their level of risk, are best treated where more high-risk patients are treated. Moreover, the higher the ICU occupancy rate, the higher is the mortality.

Cited by 102 publications

References 22 publications

Measuring the nursing workload per shift in the ICU

Measuring the nursing workload per shift in the ICU

Variability in outcome and resource use in intensive care units

Staff workload and adverse events during mechanical ventilation in neonatal intensive care units

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