Abstract
To determine whether nurse staffing and nursing workload are associated with multiple organ failure and mortality. A cross-sectional study. This study was conducted in a single tertiary-level teaching hospital during 2008-2017. The association between nurse staffing, nursing workload and prognosis was determined using daily nurse-to-patient ratios, Therapeutic Intervention Scoring System scores, Intensive Care Nursing Scoring System scores and Intensive Care Nursing Scoring System indexes. In addition, the timing of intensive care unit admission was considered. Multiple organ failure was defined according to the Sequential Organ Failure Assessment score. During the study period, 10,230 patients were included in the final analysis. Generally, the mean daily highest Therapeutic Intervention Scoring System score and Intensive Care Nursing Scoring System score were significantly higher in patients with multiple organ failure and in non-survivors. The proportion of understaffing was significantly more common in patients with multiple organ failure than in those without. The mean daily lowest nurse-to-patient ratio and the mean daily highest Intensive Care Nursing Scoring System index did not differ between survivors and non-survivors. The levels of nursing associated with workload and understaffing were at their worst on weekends. The proportion of understaffing and increased nursing workload are associated with multiple organ failure, demonstrating that an adequate level of nurse staffing in relation to patient complexity is a prerequisite for the availability and quality of critical care services. The proportion of understaffing did not differ between survivors and non-survivors. This is the first study that evaluates nurse staffing and nursing workload as potential risk factors for multiple organ failure and mortality. There is a need to ensure that intensive care units are consistently staffed based on real patient needs, 7days a week and that personnel and services are available at all times for high-risk patients.
Highlights
Multiple organ failure (MOF) is the main cause of mortality and intensive care unit (ICU) resource use among patients with non-cardiac surgery, multiple trauma and severe burns (Ciesla et al, 2005; Fröhlich et al, 2014; Kallinen, Maisniemi, Böhling, Tukiainen, & Koljonen, 2012; Lobo et al, 2011) requiring prolonged mechanical ventilation and length of ICU stay (Dewar, Tarrant, King, & Balogh, 2013; Sauaia et al, 2014)
Patients were attended by intensive care specialists who were present in the ICU for 24 hr per day, 7 days a week
In the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) values for the mean daily highest Intensive Care Nursing Scoring System (ICNSS) scores for in-hospital mortality were 0.56 in patients with early-stage MOF and 0.55 in patients with late-stage MOF
Summary
Multiple organ failure (MOF) is the main cause of mortality and intensive care unit (ICU) resource use among patients with non-cardiac surgery, multiple trauma and severe burns (Ciesla et al, 2005; Fröhlich et al, 2014; Kallinen, Maisniemi, Böhling, Tukiainen, & Koljonen, 2012; Lobo et al, 2011) requiring prolonged mechanical ventilation and length of ICU stay (Dewar, Tarrant, King, & Balogh, 2013; Sauaia et al, 2014). There is a growing awareness of the importance of appropriate staffing. If the current trend persists, the demand for critical care services will continue to increase in the decades to come (Adhikari, Fowler, Bhangwanjee, & Rubenfeld, 2010; Needham et al, 2005). The workload of health professionals is increasing due to fewer human resources (Adhikari et al, 2010; Hugonnet, Harbarth, Sax, Duncan, & Pittet, 2004; Needham et al, 2005)
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