Nursing Staffing Allocation and Patient Outcomes in the Intensive Care Unit

Wednesday, 9 July 2008
Sheila Cristina Tosta Bento, RN, MSN , School of Nursing, University of São Paulo, São Paulo, Brazil
Katia Grillo Padilha, PhD , School of Nursing, University of São Paulo, São Paulo, Brazil
Karole Mourek, PhD , Consulo Inc, Chicago, IL
Daniella Vianna Correa Krokoscz, RN, MSN , School of Nursing, University of São Paulo, São Paulo, Brazil
Kenneth W. Colbert, MS , QuadraMed Corporation, Chicago, IL

Learning Objective 1: Able to understand the issues of a study designed to analyze the effects of nursing resource allocation on specific patient outcomes (Adverse Events).

Learning Objective 2: Able to identify effects and confounding influences when comparing staffing allocation to patient outcomes.

Learning Objective #1: Able to understand the issues of a study designed to analyze the effects of nursing resource allocation on specific patient outcomes (Adverse Events).

Learning Objective #2: Able to identify effects and confounding influences when comparing staffing allocation to patient outcomes.

Background: Nursing workload is one important variable related to patients' safety and quality of care in the Intensive Care Unit (ICU). This study aims to analyze the association between nursing staff allocation and specific patient care outcomes by using a standardized workload measurement methodology to provide a more accurate and comparable control for patient care needs versus census or hours per patient day.

Design: Quantitative, descriptive and prospective study.

Population, Sample, Setting and Year: The setting was one General ICU (G-ICU) and one Cardiovascular ICU (CV-ICU) in Sao Paulo, Brazil in 2006. The sample included all patients admitted in the Units over 46 days and included a total of 328 patients and 2.382 sets of patient scores.

Findings: The average of nursing staff hours was higher than the patients demand of care in both ICU, i.e., 15.3 and 13.4 hour (p<0,001) in the G-ICU and 16.4 and 14.1 hour in the CV-ICU (p<0,001), respectively. It was observed that 20 (12.0%) patients from G-ICU and 9 (5.6%) suffered an AE. Over 46 days there was AE occurrence in 21 (46,7%) days in the G-ICU and 9 (20,0%) in the CV-ICU. It was observed that 20 (12.0%) patients from G-ICU and 9 (5.6%) suffered an AE.

Conclusions: The results showed adequate nursing hours available in both ICUs and the occurrence of AE. As nursing allocation and EA are related to many factors it is important to point out that staffing levels alone may not account for all incidents of AE.