TY - JOUR
T1 - The impact of nursing workforce skill-mix on patient outcomes in intensive care units in Victoria, Australia
AU - Ross, Paul
AU - Jaspers, Rose
AU - Watterson, Jason
AU - Topple, Michelle
AU - Birthisel, Tania
AU - Rosenow, Melissa
AU - McClure, Jason
AU - Williams, Ged
AU - Pollock, Wendy
AU - Pilcher, David
N1 - Funding Information:
We acknowledge the Australia New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resource Evaluation (CORE) for providing the data used in the current study. The authors and the ANZICS CORE management committee would like to thank clinicians, managers, data collectors, and researchers at the contributing sites presented in Appendix Table 9. The authors gratefully acknowledge the contribution and work of the following nurse unit managers without whom this study would not have been possible: Samantha Angiolella, Tania Birthisel, Andrea Bock, Nikki Harrison, Dacielle Johnson, Michelle Spence, Penny Spencer, Michelle Topple, Kate Vasallo and Jason Watterson.
Publisher Copyright:
© 2024 The Authors
PY - 2024/6
Y1 - 2024/6
N2 - 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.
AB - 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.
KW - Critical care
KW - ICU
KW - Intensive care
KW - Mortality
KW - Nurses
KW - Nursing staff
KW - Patient harm
KW - Patient safety
KW - Skill-mix
KW - Workforce
UR - http://www.scopus.com/inward/record.url?scp=85196642020&partnerID=8YFLogxK
U2 - 10.1016/j.ccrj.2024.03.002
DO - 10.1016/j.ccrj.2024.03.002
M3 - Article
C2 - 39072235
AN - SCOPUS:85196642020
SN - 1441-2772
VL - 26
SP - 135
EP - 152
JO - Critical Care and Resuscitation
JF - Critical Care and Resuscitation
IS - 2
ER -