The impact of nursing workforce skill-mix on patient outcomes in intensive care units in Victoria, Australia

IF 1.4 4区医学 Q3 CRITICAL CARE MEDICINE Critical Care and Resuscitation Pub Date : 2024-06-01 DOI:10.1016/j.ccrj.2024.03.002

Paul Ross RN, BHSc Nur, PGCert ICU, MN Research, Med Adult, PhD Candidate , Rose Jaspers RN, BN(Hons), MAdvClinNur , Jason Watterson RN, BHSc Nur, PGDipAdvNur CritCare, Med Adult, PhD , Michelle Topple RN, BHSc Nur, PGDipSci, PGCert ICU , Tania Birthisel RN, BN (Distinction), PGDip Nursing ICU, CertIV TAE, MProfEd&Trng , Melissa Rosenow , Jason McClure MB ChB, MRCP, FRCA, FCICM, Dip Engineering , Ged Williams AO, RN, PGCert ICU, BHSc. Adv. Nursing, LLM, MHA, FACN, FACHSM, FAAN , Wendy Pollock RN, RM, Grad Cert Adv Learning & Leadership, Grad Dip Ed, Grad Dip Crit Car Nsg, PhD , David Pilcher MBBS MRCP(UK) FCICM FRACP

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Abstract

Objective

This article aims to examine the impact of nursing workforce skill-mix (percentage of critical care registered nurses [CCRN]) in the intensive care unit (ICU) during a patient's stay.

Design

Registry linked cohort study of the Australian and New Zealand Intensive Care Society Adult Patient Database and the Critical Health Resources Information System using real-time nursing workforce data.

Settings

Fifteen public and 5 private hospital ICUs in Victoria, Australia.

Participants

There were 16,618 adult patients admitted between 1 December 2021 and 30 September 2022.

Main outcome measures

Primary outcome: in-hospital mortality. Secondary outcomes: in-ICU mortality, development of delirium, pressure injury, duration of stay in-ICU and hospital, after-hours discharge from ICU and readmission to ICU.

Results

In total, 6563 (39.5%) patients were cared for in ICUs with >75% CCRN, 7695 (46.3%) in ICUs with 50–75% CCRN, and 2360 (14.2%) in ICUs with <50% CCRN. In-hospital mortality was 534 (8.1%) vs. 859 (11.2%) vs. 252 (10.7%) respectively. After adjusting for confounders, patients cared for in ICUs with 50–75% CCRN (adjusted OR 1.21 [95% CI 1.02–1.45]) were more likely to die compared to patients in ICUs with >75% CCRN. A similar but non-significant trend was seen in ICUs with <50% CCRN (adjusted OR 1.21 [95% CI 0.94–1.55]), when compared to patients in ICUs with >75% CCRN. In-ICU mortality, delirium, pressure injuries, after-hours discharge and ICU length of stay were lower in ICUs with CCRN>75%.

Conclusion

The nursing skill-mix in ICU impacts outcomes and should be routinely monitored. Health system regulators, hospital administrators and ICU leaders should ensure nursing workforce planning and education align with these findings to maximise patient outcomes.

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澳大利亚维多利亚州重症监护病房护理人员技能组合对患者预后的影响

本文旨在研究重症监护病房（ICU）护理人员技能组合（重症监护注册护士[CCRN]的比例）对患者住院期间的影响。参与者2021年12月1日至2022年9月30日期间收治的16618名成人患者。主要结果测量主要结果：院内死亡率。次要结果：重症监护室内死亡率、谵妄发生率、压伤、重症监护室和住院时间、重症监护室下班后出院情况以及重症监护室再入院情况。结果共有 6563 名（39.5%）患者在 CCRN 为 75% 的重症监护室接受治疗，7695 名（46.3%）患者在 CCRN 为 50%-75% 的重症监护室接受治疗，2360 名（14.2%）患者在 CCRN 为 50% 的重症监护室接受治疗。院内死亡率分别为 534 (8.1%) vs. 859 (11.2%) vs. 252 (10.7%)。在对混杂因素进行调整后，与 CCRN 为 50%-75% 的重症监护病房的患者相比，CCRN 为 50%-75% 的重症监护病房的患者更容易死亡（调整后 OR 为 1.21 [95% CI 为 1.02-1.45]）。与CCRN为75%的重症监护病房相比，CCRN为50%的重症监护病房（调整后OR值为1.21 [95% CI 0.94-1.55]）的患者也有类似的趋势，但并不显著。结论 ICU 中的护理技能组合对治疗效果有影响，应进行常规监测。卫生系统监管者、医院管理者和重症监护室领导应确保护理人员的规划和教育与这些研究结果相一致，以最大限度地提高患者的治疗效果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Care and Resuscitation CRITICAL CARE MEDICINE-

CiteScore

7.70

自引率

3.40%

发文量

审稿时长

>12 weeks

期刊介绍： ritical Care and Resuscitation (CC&R) is the official scientific journal of the College of Intensive Care Medicine (CICM). The Journal is a quarterly publication (ISSN 1441-2772) with original articles of scientific and clinical interest in the specialities of Critical Care, Intensive Care, Anaesthesia, Emergency Medicine and related disciplines. The Journal is received by all Fellows and trainees, along with an increasing number of subscribers from around the world. The CC&R Journal currently has an impact factor of 3.3, placing it in 8th position in world critical care journals and in first position in the world outside the USA and Europe.