Patient Mortality Is Associated With Staff Resources and Workload in the ICU. Issue 8 (August 2015)

• Record Type: Journal Article
• Authors: Neuraz, Antoine; Guérin, Claude; Payet, Cécile; Polazzi, Stéphanie; Aubrun, Frédéric; Dailler, Frédéric; Lehot, Jean-Jacques; Piriou, Vincent; Neidecker, Jean; Rimmelé, Thomas; Schott, Anne-Marie; Duclos, Antoine
• Is Part Of: Critical care medicine. Volume 43:Issue 8(2015)
• Publication Date: 2015-08
• Subjects: Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000001015
• Languages: English
• ISSNs: 0090-3493

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Objective:</title> <p>Matching healthcare staff resources to patient needs in the ICU is a key factor for quality of care. We aimed to assess the impact of the staffing-to-patient ratio and workload on ICU mortality.</p> </sec> <sec> <title>Design:</title> <p>We performed a multicenter longitudinal study using routinely collected hospital data.</p> </sec> <sec> <title>Setting:</title> <p>Information pertaining to every patient in eight ICUs from four university hospitals from January to December 2013 was analyzed.</p> </sec> <sec> <title>Patients:</title> <p>A total of 5, 718 inpatient stays were included.</p> </sec> <sec> <title>Interventions:</title> <p>None.</p> </sec> <sec> <title>Measurements and Main Results:</title> <p>We used a shift-by-shift varying measure of the patient-to-caregiver ratio in combination with workload to establish their relationships with ICU mortality over time, excluding patients with decision to forego life-sustaining therapy. Using a multilevel Poisson regression, we quantified ICU mortality-relative risk, adjusted for patient turnover, severity, and staffing levels. The risk of death was increased by 3.5 (95% CI, 1.3–9.1) when the patient-to-nurse ratio was greater than 2.5, and it was increased by 2.0 (95% CI, 1.3–3.2) when the patient-to-physician ratio exceeded 14. The highest ratios occurred more frequently during the weekend for nurse staffing and during the night for physicians (<italic>p</italic> < 0.001). High patient turnover (adjusted relative risk, 5.6 [2.0–15.0]) and the volume of life-sustaining procedures performed by staff (adjusted relative risk, 5.9 [4.3–7.9]) were also associated with increased mortality.</p> </sec> <sec> <title>Conclusions:</title> <p>This study proposes evidence-based thresholds for patient-to-caregiver ratios, above which patient safety may be endangered in the ICU. Real-time monitoring of staffing levels and workload is feasible for adjusting caregivers' resources to patients' needs.</p> </sec> </abstract>