Intensive Care Unit Utilization Following Major Surgery and the Nurse Work Environment.

Background: Across hospitals, there is wide variation in ICU utilization after surgery. However, it is unknown whether and to what extent the nurse work environment is associated with a patient's odds of admission to an intensive care unit.

Purpose: To estimate the relationship between hospitals' nurse work environment and a patient's likelihood of ICU admission and mortality following surgery.

Methods: A cross-sectional study of 269 764 adult surgical patients in 453 hospitals was conducted. Logistic regression models were used to estimate the effects of the work environment on the odds of patients' admission to the intensive care unit and mortality.

Results: Patients in hospitals with good work environments had 16% lower odds of intensive care unit admission and 15% lower odds of mortality or intensive care unit admission than patients in hospitals with mixed or poor environments.

Conclusions: Patients in hospitals with better nurse work environments were less likely to be admitted to an intensive care unit and less likely to die. Hospitals with better nurse work environments may be better equipped to provide postoperative patient care on lower acuity units.