723: BEDSIDE NURSE STAFFING ON PATIENT OUTCOMES AND THROUGHPUT IN A PEDIATRIC CARDIAC INTENSIVE CARE UNIT

Abstract

Introduction: Healthcare throughput is the progression of patients from admission to discharge, limited by bed occupancy and hospital capacity. This study examines Heart Center throughput, cascading effects of limited beds, transfer delays, and nursing assignments on outcomes utilizing elective surgery cancellation during the initial COVID-19 pandemic wave. Methods: Nursing assignments, patient data, and transfers were collected. Elective surgery cancellation was March-May 2020. Heart Center occupancy (Stepdown Unit and Cardiac Intensive Care Unit), transfer delays, and patient outcomes were analyzed controlling for patient factors, surgical risk, staffing, and time effects. Setting: Retrospective single-center study Patients: Heart Center admissions January 1, 2018 – December 31, 2020. Results: There were 2,589 patients, median age 5 months (6 days-4 years), 1,543 (60%) surgical, 1,046 (40%) medical. Mortality was 3.9% (n=101), median stay 5 days (3-11 days), median 1:1 nursing assignments 40% (33%-48%), median occupancy 54% (43%-65%) for Stepdown Unit and 81% (74%-85%) for Cardiac Intensive Care Unit. Every 10% increase in Stepdown Unit occupancy had a 0.5-day increase in Cardiac Intensive Care Unit stay (p=0.044), 2.1% increase 2-day readmission (p=0.023), and 2.6% mortality increase (p< 0.001). Every 10% increase in Cardiac Intensive Care Unit occupancy had 3.4% increase in surgical delay (p=0.016) and 6.5% increase in transfer delay (p=0.020). Elective surgery cancellation reduced high occupancy days (23% to 10%, p< 0.001), increased 1:1 nursing (34% to 55%, p< 0.001), decreased transfer delays (19% to 4%, p=0.008), and decreased mortality (3.7% to 1.5%, p=0.044). Conclusions: Cancelation of elective surgery was associated with increased 1:1 nursing assignments and decreased mortality. Increased Cardiac Stepdown Unit occupancy resulted in longer Cardiac Intensive Care Unit stay, and increased Cardiac Intensive Care Unit occupancy increased transfer and surgical delays. Additional studies are need to understand the interaction of staffing and outcomes.