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Hospital mortality in relation to staff workload: a 4-year study in an adult intensive-care unit

Few studies have examined mortality rates in relation to the workload of hospital staff. We investigated this issue in one adult intensive-care unit (ICU) in the UK. We measured ICU workload per shift during each patient's stay for all admissions between 1992 and 1995 that met criteria for adjustmen... Full description

Journal Title: The Lancet (British edition) 2000-07-15, Vol.356 (9225), p.185-189
Main Author: Tarnow-Mordi, WO
Other Authors: Hau, C , Warden, A , Shearer, AJ
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: London: Elsevier Ltd
ID: ISSN: 0140-6736
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recordid: cdi_proquest_miscellaneous_764111657
title: Hospital mortality in relation to staff workload: a 4-year study in an adult intensive-care unit
format: Article
creator:
  • Tarnow-Mordi, WO
  • Hau, C
  • Warden, A
  • Shearer, AJ
subjects:
  • Abridged Index Medicus
  • Adolescent
  • Adult
  • Aged
  • Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
  • APACHE
  • Bed Occupancy - statistics & numerical data
  • Biological and medical sciences
  • Confidence Intervals
  • Critical care
  • Critical Care - statistics & numerical data
  • Emergency and intensive care: techniques, logistics
  • Female
  • Forecasting
  • Hospital Mortality
  • Humans
  • Intensive care medicine
  • Intensive care unit. Emergency transport systems. Emergency, hospital ward
  • Intensive Care Units
  • Length of Stay - statistics & numerical data
  • Logistic Models
  • Male
  • Medical personnel
  • Medical sciences
  • Middle Aged
  • Mortality
  • Nurses
  • Nursing
  • Nursing Care - statistics & numerical data
  • Nursing Staff, Hospital - statistics & numerical data
  • Odds Ratio
  • Patient Admission - statistics & numerical data
  • Patient outcomes
  • Personnel Staffing and Scheduling - statistics & numerical data
  • Reproducibility of Results
  • Retrospective Studies
  • Risk Factors
  • Scotland - epidemiology
  • Statistics
  • Workforce
  • Workload - statistics & numerical data
  • Workloads
ispartof: The Lancet (British edition), 2000-07-15, Vol.356 (9225), p.185-189
description: Few studies have examined mortality rates in relation to the workload of hospital staff. We investigated this issue in one adult intensive-care unit (ICU) in the UK. We measured ICU workload per shift during each patient's stay for all admissions between 1992 and 1995 that met criteria for adjustment of mortality risk by the APACHE II equation (n=1050). APACHE II data were validated by one observer. Measures of workload in each patient's stay included occupancy, total ICU nursing requirement as defined by the UK Intensive Care Society, and the ratio of occupied to appropriately staffed beds. Over the period, staffing was appropriate for between 4·1 and 5·3 occupied beds (1·3 nurses per patient). There were 337 deaths, 49 more (95% CI 34–65) than predicted by the APACHE II equation. Median occupancy was 5·8 beds, and median nursing requirement was 1·6 per patient. On multiple logistic regression analysis, adjusted mortality was more than two times higher (odds ratio 3·1 [1·9–5·0]) in patients exposed to high than in those exposed to low ICU workload, defined by average nursing requirement per occupied bed and peak occupancy; the unadjusted odds ratio for this comparison was 4·0 (2·6–6·2). After exclusion of measures of nursing requirement, adjusted mortality increased with the ratio of occupied to appropriately staffed beds during each patient's stay. All logistic regression models fitted the data satisfactorily. Variations in mortality may be partly explained by excess ICU workload. This methodology may have implications for planning and clinical governance.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0140-6736
fulltext: fulltext
issn:
  • 0140-6736
  • 1474-547X
url: Link


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descriptionFew studies have examined mortality rates in relation to the workload of hospital staff. We investigated this issue in one adult intensive-care unit (ICU) in the UK. We measured ICU workload per shift during each patient's stay for all admissions between 1992 and 1995 that met criteria for adjustment of mortality risk by the APACHE II equation (n=1050). APACHE II data were validated by one observer. Measures of workload in each patient's stay included occupancy, total ICU nursing requirement as defined by the UK Intensive Care Society, and the ratio of occupied to appropriately staffed beds. Over the period, staffing was appropriate for between 4·1 and 5·3 occupied beds (1·3 nurses per patient). There were 337 deaths, 49 more (95% CI 34–65) than predicted by the APACHE II equation. Median occupancy was 5·8 beds, and median nursing requirement was 1·6 per patient. On multiple logistic regression analysis, adjusted mortality was more than two times higher (odds ratio 3·1 [1·9–5·0]) in patients exposed to high than in those exposed to low ICU workload, defined by average nursing requirement per occupied bed and peak occupancy; the unadjusted odds ratio for this comparison was 4·0 (2·6–6·2). After exclusion of measures of nursing requirement, adjusted mortality increased with the ratio of occupied to appropriately staffed beds during each patient's stay. All logistic regression models fitted the data satisfactorily. Variations in mortality may be partly explained by excess ICU workload. This methodology may have implications for planning and clinical governance.
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descriptionFew studies have examined mortality rates in relation to the workload of hospital staff. We investigated this issue in one adult intensive-care unit (ICU) in the UK. We measured ICU workload per shift during each patient's stay for all admissions between 1992 and 1995 that met criteria for adjustment of mortality risk by the APACHE II equation (n=1050). APACHE II data were validated by one observer. Measures of workload in each patient's stay included occupancy, total ICU nursing requirement as defined by the UK Intensive Care Society, and the ratio of occupied to appropriately staffed beds. Over the period, staffing was appropriate for between 4·1 and 5·3 occupied beds (1·3 nurses per patient). There were 337 deaths, 49 more (95% CI 34–65) than predicted by the APACHE II equation. Median occupancy was 5·8 beds, and median nursing requirement was 1·6 per patient. On multiple logistic regression analysis, adjusted mortality was more than two times higher (odds ratio 3·1 [1·9–5·0]) in patients exposed to high than in those exposed to low ICU workload, defined by average nursing requirement per occupied bed and peak occupancy; the unadjusted odds ratio for this comparison was 4·0 (2·6–6·2). After exclusion of measures of nursing requirement, adjusted mortality increased with the ratio of occupied to appropriately staffed beds during each patient's stay. All logistic regression models fitted the data satisfactorily. Variations in mortality may be partly explained by excess ICU workload. This methodology may have implications for planning and clinical governance.
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30Odds Ratio
31Patient Admission - statistics & numerical data
32Patient outcomes
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34Reproducibility of Results
35Retrospective Studies
36Risk Factors
37Scotland - epidemiology
38Statistics
39Workforce
40Workload - statistics & numerical data
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abstractFew studies have examined mortality rates in relation to the workload of hospital staff. We investigated this issue in one adult intensive-care unit (ICU) in the UK. We measured ICU workload per shift during each patient's stay for all admissions between 1992 and 1995 that met criteria for adjustment of mortality risk by the APACHE II equation (n=1050). APACHE II data were validated by one observer. Measures of workload in each patient's stay included occupancy, total ICU nursing requirement as defined by the UK Intensive Care Society, and the ratio of occupied to appropriately staffed beds. Over the period, staffing was appropriate for between 4·1 and 5·3 occupied beds (1·3 nurses per patient). There were 337 deaths, 49 more (95% CI 34–65) than predicted by the APACHE II equation. Median occupancy was 5·8 beds, and median nursing requirement was 1·6 per patient. On multiple logistic regression analysis, adjusted mortality was more than two times higher (odds ratio 3·1 [1·9–5·0]) in patients exposed to high than in those exposed to low ICU workload, defined by average nursing requirement per occupied bed and peak occupancy; the unadjusted odds ratio for this comparison was 4·0 (2·6–6·2). After exclusion of measures of nursing requirement, adjusted mortality increased with the ratio of occupied to appropriately staffed beds during each patient's stay. All logistic regression models fitted the data satisfactorily. Variations in mortality may be partly explained by excess ICU workload. This methodology may have implications for planning and clinical governance.
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doi10.1016/S0140-6736(00)02478-8