The impact of nursing workforce skill-mix on patient outcomes in intensive care units in Victoria, Australia
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. Registry linked cohort study of the Australian and New Zealand Intensive Care Society Adult Patient Database an...
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| Veröffentlicht in: | Critical care and resuscitation 2024-06, Vol.26 (2), p.135-152 |
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| creator | Ross, Paul Jaspers, Rose Watterson, Jason Topple, Michelle Birthisel, Tania Rosenow, Melissa McClure, Jason Williams, Ged Pollock, Wendy Pilcher, David |
| description | 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.
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.
Fifteen public and 5 private hospital ICUs in Victoria, Australia.
There were 16,618 adult patients admitted between 1 December 2021 and 30 September 2022.
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.
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 75% CCRN. A similar but non-significant trend was seen 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%.
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. |
| doi_str_mv | 10.1016/j.ccrj.2024.03.002 |
| format | Article |
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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.
Fifteen public and 5 private hospital ICUs in Victoria, Australia.
There were 16,618 adult patients admitted between 1 December 2021 and 30 September 2022.
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.
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%.
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.</description><identifier>ISSN: 1441-2772</identifier><identifier>EISSN: 2652-9335</identifier><identifier>DOI: 10.1016/j.ccrj.2024.03.002</identifier><identifier>PMID: 39072235</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Critical care ; ICU ; Intensive care ; Mortality ; Nurses ; Nursing staff ; Original ; Patient harm ; Patient safety ; Skill-mix ; Workforce</subject><ispartof>Critical care and resuscitation, 2024-06, Vol.26 (2), p.135-152</ispartof><rights>2024 The Authors</rights><rights>2024 The Authors.</rights><rights>2024 The Authors 2024</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c337t-582bb28c82d80d9ae39a03704c6605cf371c1f2b690842d049a7415fb4b6645b3</cites><orcidid>0000-0002-4143-5559</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11282374/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11282374/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39072235$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ross, Paul</creatorcontrib><creatorcontrib>Jaspers, Rose</creatorcontrib><creatorcontrib>Watterson, Jason</creatorcontrib><creatorcontrib>Topple, Michelle</creatorcontrib><creatorcontrib>Birthisel, Tania</creatorcontrib><creatorcontrib>Rosenow, Melissa</creatorcontrib><creatorcontrib>McClure, Jason</creatorcontrib><creatorcontrib>Williams, Ged</creatorcontrib><creatorcontrib>Pollock, Wendy</creatorcontrib><creatorcontrib>Pilcher, David</creatorcontrib><title>The impact of nursing workforce skill-mix on patient outcomes in intensive care units in Victoria, Australia</title><title>Critical care and resuscitation</title><addtitle>Crit Care Resusc</addtitle><description>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.
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.
Fifteen public and 5 private hospital ICUs in Victoria, Australia.
There were 16,618 adult patients admitted between 1 December 2021 and 30 September 2022.
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.
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%.
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.</description><subject>Critical care</subject><subject>ICU</subject><subject>Intensive care</subject><subject>Mortality</subject><subject>Nurses</subject><subject>Nursing staff</subject><subject>Original</subject><subject>Patient harm</subject><subject>Patient safety</subject><subject>Skill-mix</subject><subject>Workforce</subject><issn>1441-2772</issn><issn>2652-9335</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kU1rFTEUhoMo9lr9Ay4kSxfOmK9JJiBIKVaFgpvqNmQymfbcziTXJHPVf99cby26EQKB5DnvOZwHoZeUtJRQ-XbbOpe2LSNMtIS3hLBHaMNkxxrNefcYbagQtGFKsRP0LOdtBbSQ6ik64Zooxni3QfPVjcew7KwrOE44rClDuMY_YrqdYnIe51uY52aBnzgGvLMFfKjkWlxcfMYQ6ik-ZNh77GzyeA1Qfr9_A1diAvsGn625JDuDfY6eTHbO_sX9fYq-Xny4Ov_UXH75-Pn87LJxnKvSdD0bBta7no09GbX1XFvCFRFOStK5iSvq6MQGqUkv2EiEtkrQbhrEIKXoBn6K3h9zd-uw-NHVkWt_s0uw2PTLRAvm358AN-Y67g2lrGdciZrw-j4hxe-rz8UskJ2fZxt8XLPhpO9krzVnFWVH1KWYc_LTQx9KzMGT2ZqDJ3PwZAg3VUMtevX3hA8lf8RU4N0R8HVPe_DJZFdX7_wIybtixgj_y78DZ0-l1g</recordid><startdate>20240601</startdate><enddate>20240601</enddate><creator>Ross, Paul</creator><creator>Jaspers, Rose</creator><creator>Watterson, Jason</creator><creator>Topple, Michelle</creator><creator>Birthisel, Tania</creator><creator>Rosenow, Melissa</creator><creator>McClure, Jason</creator><creator>Williams, Ged</creator><creator>Pollock, Wendy</creator><creator>Pilcher, David</creator><general>Elsevier B.V</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-4143-5559</orcidid></search><sort><creationdate>20240601</creationdate><title>The impact of nursing workforce skill-mix on patient outcomes in intensive care units in Victoria, Australia</title><author>Ross, Paul ; Jaspers, Rose ; Watterson, Jason ; Topple, Michelle ; Birthisel, Tania ; Rosenow, Melissa ; McClure, Jason ; Williams, Ged ; Pollock, Wendy ; Pilcher, David</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c337t-582bb28c82d80d9ae39a03704c6605cf371c1f2b690842d049a7415fb4b6645b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Critical care</topic><topic>ICU</topic><topic>Intensive care</topic><topic>Mortality</topic><topic>Nurses</topic><topic>Nursing staff</topic><topic>Original</topic><topic>Patient harm</topic><topic>Patient safety</topic><topic>Skill-mix</topic><topic>Workforce</topic><toplevel>online_resources</toplevel><creatorcontrib>Ross, Paul</creatorcontrib><creatorcontrib>Jaspers, Rose</creatorcontrib><creatorcontrib>Watterson, Jason</creatorcontrib><creatorcontrib>Topple, Michelle</creatorcontrib><creatorcontrib>Birthisel, Tania</creatorcontrib><creatorcontrib>Rosenow, Melissa</creatorcontrib><creatorcontrib>McClure, Jason</creatorcontrib><creatorcontrib>Williams, Ged</creatorcontrib><creatorcontrib>Pollock, Wendy</creatorcontrib><creatorcontrib>Pilcher, David</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Critical care and resuscitation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ross, Paul</au><au>Jaspers, Rose</au><au>Watterson, Jason</au><au>Topple, Michelle</au><au>Birthisel, Tania</au><au>Rosenow, Melissa</au><au>McClure, Jason</au><au>Williams, Ged</au><au>Pollock, Wendy</au><au>Pilcher, David</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The impact of nursing workforce skill-mix on patient outcomes in intensive care units in Victoria, Australia</atitle><jtitle>Critical care and resuscitation</jtitle><addtitle>Crit Care Resusc</addtitle><date>2024-06-01</date><risdate>2024</risdate><volume>26</volume><issue>2</issue><spage>135</spage><epage>152</epage><pages>135-152</pages><issn>1441-2772</issn><eissn>2652-9335</eissn><abstract>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.
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.
Fifteen public and 5 private hospital ICUs in Victoria, Australia.
There were 16,618 adult patients admitted between 1 December 2021 and 30 September 2022.
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.
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%.
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.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>39072235</pmid><doi>10.1016/j.ccrj.2024.03.002</doi><tpages>18</tpages><orcidid>https://orcid.org/0000-0002-4143-5559</orcidid><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Critical care ICU Intensive care Mortality Nurses Nursing staff Original Patient harm Patient safety Skill-mix Workforce |
| title | The impact of nursing workforce skill-mix on patient outcomes in intensive care units in Victoria, Australia |
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