The relationship between nursing skill mix and severity of illness of patients admitted in Australian and New Zealand intensive care units.

Adult Humans Retrospective Studies New Zealand Critical Illness Australia Intensive Care Units Patient Acuity Hospital Mortality
Critical care Critical care nursing Hospital mortality Intensive care units Nurses Outcomes Skill mix Workforce

Journal

Australian critical care : official journal of the Confederation of Australian Critical Care Nurses
ISSN: 1036-7314
Titre abrégé: Aust Crit Care
Pays: Australia
ID NLM: 9207852

Informations de publication

Date de publication:
09 2023
Historique:
received: 19 03 2022
revised: 22 11 2022
accepted: 23 11 2022
medline: 25 8 2023
pubmed: 3 2 2023
entrez: 2 2 2023
Statut: ppublish

Résumé

Critically ill patients in the intensive care environment require an appropriate nursing workforce to improve quality of care and patient outcomes. However, limited information exists as to the relationship between severity of illness and nursing skill mix in the intensive care. The aim of this study was to describe the variation in nursing skill mix across different hospital types and to determine if this was associated with severity of illness of critically ill patients admitted to adult intensive care units (ICUs) in Australia and New Zealand. A retrospective cohort study using the Australia and New Zealand Intensive Care Society Adult Patient Database (to provide information on patient demographics, severity of illness, and outcome) and the Critical Care Resources Registry (to provide information on annual nursing staffing levels and hospital type) from July 2014 to June 2020. Four hospital types (metropolitan, private, rural/regional, and tertiary) and three patient groups (elective surgical, emergency surgical, and medical) were examined. The main outcome measure was the proportion of critical care specialist registered nurses (RNs) expressed as a percentage of the full-time equivalent (FTE) of total RNs working within each ICU each year, as reported annually to the Critical Care Resources Registry. Data were examined for 184 ICUs in Australia and New Zealand. During the 6-year study period, 770 747 patients were admitted to these ICUs. Across Australia and New Zealand, the median percentage of registered nursing FTE with a critical care qualification for each ICU (n = 184) was 59.1% (interquartile range [IQR] = 48.9-71.6). The percentage FTE of critical care specialist RNs was highest in private [63.7% (IQR = 52.6-78.2)] and tertiary ICUs [58.1% (IQR = 51.2-70.2)], followed by metropolitan ICUs [56.0% (IQR = 44.5-68.9)] with the lowest in rural/regional hospitals [55.9% (IQR = 44.9-70.0)]. In ICUs with higher percentage FTE of critical care specialist RNs, patients had higher severity of illness, most notably in tertiary and private ICUs. This relationship was persistent across all hospital types when examining subgroups of emergency surgical and medical patients and in multivariable analysis after adjusting for the type of hospital and relative percentage of each diagnostic group. In Australian and New Zealand ICUs, the highest acuity patients are cared for by nursing teams with the highest percentage FTE of critical care specialist RNs. The Australian and New Zealand healthcare system has a critical care nursing workforce which scales to meet the acuity of ICU patients across Australia and New Zealand.

Sections du résumé

BACKGROUND
Critically ill patients in the intensive care environment require an appropriate nursing workforce to improve quality of care and patient outcomes. However, limited information exists as to the relationship between severity of illness and nursing skill mix in the intensive care.
OBJECTIVE
The aim of this study was to describe the variation in nursing skill mix across different hospital types and to determine if this was associated with severity of illness of critically ill patients admitted to adult intensive care units (ICUs) in Australia and New Zealand.
DESIGN & SETTING
A retrospective cohort study using the Australia and New Zealand Intensive Care Society Adult Patient Database (to provide information on patient demographics, severity of illness, and outcome) and the Critical Care Resources Registry (to provide information on annual nursing staffing levels and hospital type) from July 2014 to June 2020. Four hospital types (metropolitan, private, rural/regional, and tertiary) and three patient groups (elective surgical, emergency surgical, and medical) were examined.
MAIN OUTCOME MEASURE
The main outcome measure was the proportion of critical care specialist registered nurses (RNs) expressed as a percentage of the full-time equivalent (FTE) of total RNs working within each ICU each year, as reported annually to the Critical Care Resources Registry.
RESULTS
Data were examined for 184 ICUs in Australia and New Zealand. During the 6-year study period, 770 747 patients were admitted to these ICUs. Across Australia and New Zealand, the median percentage of registered nursing FTE with a critical care qualification for each ICU (n = 184) was 59.1% (interquartile range [IQR] = 48.9-71.6). The percentage FTE of critical care specialist RNs was highest in private [63.7% (IQR = 52.6-78.2)] and tertiary ICUs [58.1% (IQR = 51.2-70.2)], followed by metropolitan ICUs [56.0% (IQR = 44.5-68.9)] with the lowest in rural/regional hospitals [55.9% (IQR = 44.9-70.0)]. In ICUs with higher percentage FTE of critical care specialist RNs, patients had higher severity of illness, most notably in tertiary and private ICUs. This relationship was persistent across all hospital types when examining subgroups of emergency surgical and medical patients and in multivariable analysis after adjusting for the type of hospital and relative percentage of each diagnostic group.
CONCLUSIONS
In Australian and New Zealand ICUs, the highest acuity patients are cared for by nursing teams with the highest percentage FTE of critical care specialist RNs. The Australian and New Zealand healthcare system has a critical care nursing workforce which scales to meet the acuity of ICU patients across Australia and New Zealand.

Identifiants

DOI: 10.1016/j.aucc.2022.11.012 PMID: 36732156
pubmed: 36732156
pii: S1036-7314(22)00245-4
doi: 10.1016/j.aucc.2022.11.012
pii:
doi:

Types de publication

Journal Article

Langues

eng

Pagination

813-820

Informations de copyright

Copyright © 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.

Auteurs

Paul Ross (P)

Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, VIC 3004, Australia; School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia. Electronic address: P.Ross@alfred.org.au.

Ary Serpa-Neto (A)

Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Department of Critical Care, University of Melbourne, Melbourne, Australia; Hospital Israelita Albert Einstein, São Paulo, Brazil. Electronic address: Ary.Serpaneto@monash.edu.

Sing Chee Tan (S)

Northern Health, Melbourne, Australia. Electronic address: sing.tan@nh.org.au.

Jason Watterson (J)

School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia; Department of Intensive Care Medicine, Frankston Hospital, Peninsula Health, Frankston, VIC 3199, Australia. Electronic address: Jason.Watterson@monash.edu.

Dragan Ilic (D)

Medical Education Research & Quality (MERQ), School of Public Health & Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, 3004, Victoria, Australia. Electronic address: Dragan.Ilic@monash.edu.

Carol L Hodgson (CL)

Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, VIC 3004, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. Electronic address: Carol.Hodgson@monash.edu.

Andrew Udy (A)

Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, VIC 3004, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. Electronic address: Andrew.Udy@monash.edu.

Edward Litton (E)

Australian and New Zealand Intensive Care Society Centre for Outcome and Resources Evaluation, Camberwell, VIC 3124, Australia; Department of Intensive Care, Fiona Stanley Hospital, Robin Warren Drive, Perth, WA 6150, Australia. Electronic address: Ed_litton@hotmail.com.

David Pilcher (D)

Department of Intensive Care, Alfred Health, Commercial Road, Melbourne, VIC 3004, Australia; Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Australian and New Zealand Intensive Care Society Centre for Outcome and Resources Evaluation, Camberwell, VIC 3124, Australia. Electronic address: David.Pilcher@monash.edu.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › The relationship between nursing skill mix and...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › The relationship between nursing skill mix and...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › The relationship between nursing skill mix and...
questionsmedicales.fr › Régions géographiques › Océanie › Australasie › Nouvelle-Zélande › The relationship between nursing skill mix and...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Caractéristiques de la maladie › Maladie grave › The relationship between nursing skill mix and...
questionsmedicales.fr › Régions géographiques › Océanie › Australasie › Australie › The relationship between nursing skill mix and...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Établissements de santé › Unités hospitalières › Unités de soins intensifs › The relationship between nursing skill mix and...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enquêtes et questionnaires › Enquêtes de santé › Indicateurs d'état de santé › Acuité des besoins du patient › The relationship between nursing skill mix and...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Registre civil › Mortalité › Mortalité hospitalière › The relationship between nursing skill mix and...