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Ross P, Jaspers R, Watterson J, Topple M, Birthisel T, Rosenow M, McClure J, Williams G, Pollock W, Pilcher D. The impact of nursing workforce skill-mix on patient outcomes in intensive care units in Victoria, Australia. CRIT CARE RESUSC 2024; 26:135-152. [PMID: 39072235 PMCID: PMC11282374 DOI: 10.1016/j.ccrj.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 07/30/2024]
Abstract
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.
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Affiliation(s)
- Paul Ross
- Department of Intensive Care, Alfred Health, 55 Commercial Road, Melbourne, 3181, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Australia
| | - Rose Jaspers
- School of Nursing and Midwifery, Monash University, Clayton, 3800, VIC, Australia
| | - Jason Watterson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Australia
- School of Nursing & Midwifery, La Trobe University, Royal Melbourne Hospital Clinical School, Melbourne, Australia
| | - Michelle Topple
- Bed Management and Acute Ambulatory Services, Austin Health, 145 Studley Rd, Heidelberg, Melbourne, VIC, Australia
| | - Tania Birthisel
- Department of Intensive Care, Alfred Health, 55 Commercial Road, Melbourne, 3181, VIC, Australia
| | - Melissa Rosenow
- Adult Retrieval Victoria, 75 Brady St, South Melbourne, VIC, Australia
| | - Jason McClure
- Department of Intensive Care, Alfred Health, 55 Commercial Road, Melbourne, 3181, VIC, Australia
- Adult Retrieval Victoria, 75 Brady St, South Melbourne, VIC, Australia
| | - Ged Williams
- School of Nursing and Midwifery, Monash University, Clayton, 3800, VIC, Australia
- Alfred Health Executive, Alfred Health, 55 Commercial Road, Melbourne, 3181, VIC, Australia
| | - Wendy Pollock
- School of Nursing and Midwifery, Monash University, Clayton, 3800, VIC, Australia
| | - David Pilcher
- Department of Intensive Care, Alfred Health, 55 Commercial Road, Melbourne, 3181, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Australia
- Australian and New Zealand Intensive Care Society Centre for Outcome and Resources Evaluation, Prahran, 3004, VIC, Australia
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Spitzer EG, Kaitz J, Fix GM, Harvey KLL, Stadnick NA, Sullivan JL, Williamson AK, Miller CJ. Developing Relational Coordination: A Qualitative Study of Outpatient Mental Health Teams. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023:10.1007/s10488-023-01261-2. [PMID: 36892721 PMCID: PMC9996570 DOI: 10.1007/s10488-023-01261-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/10/2023]
Abstract
Previous studies have shown Relational Coordination improves team functioning in healthcare settings. The aim of this study was to examine the relational factors needed to support team functioning in outpatient mental health care teams with low staffing ratios. We interviewed interdisciplinary mental health teams that had achieved high team functioning despite low staffing ratios in U.S. Department of Veterans Affairs medical centers. We conducted qualitative interviews with 21 interdisciplinary team members across three teams within two medical centers. We used directed content analysis to code the transcripts with a priori codes based on the Relational Coordination dimensions, while also being attentive to emergent themes. We found that all seven dimensions of Relational Coordination were relevant to improved team functioning: frequent communication, timely communication, accurate communication, problem-solving communication, shared goals, shared knowledge, and mutual respect. Participants also described these dimensions as reciprocal processes that influenced each other. In conclusion, relational Coordination dimensions can play pivotal roles in improving team functioning both individually and in combination. Communication dimensions were a catalyst for developing relationship dimensions; once relationships were developed, there was a mutually reinforcing cycle between communication and relationship dimensions. Our results suggest that establishing high-functioning mental health care teams, even in low-staffed settings, requires encouraging frequent communication within teams. Moreover, attention should be given to ensuring appropriate representation of disciplines among leadership and defining roles of team members when teams are formed.
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Affiliation(s)
- Elizabeth G Spitzer
- VA Boston Healthcare System Center for Healthcare Organization and Implementation Research, Boston, Massachusetts and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States.
| | - Jenesse Kaitz
- VA Bedford Center for Healthcare Organization and Implementation Research, Bedford, Massachusetts, United States
| | - Gemmae M Fix
- VA Bedford Healthcare System Center for Healthcare Organization and Implementation Research and Boston University School of Public Health Boston, Bedford, Massachusetts, United States
| | - Kimberly L L Harvey
- VA Boston Healthcare System Center for Healthcare Organization and Implementation Research, Boston, Massachusetts and Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States
| | - Nicole A Stadnick
- Department of Psychiatry, University of California, San Diego; UC San Diego, Altman Clinical and Translational Research, Institute, Dissemination and Implementation Science Center, La Jolla, California; and Child and Adolescent Services Research Center, San Diego, California, United States
| | - Jennifer L Sullivan
- A Medical Center, Center of Innovation in Long Term Services and Supports and Brown University School of Public Health, Providence, Providence, Rhode Island, United States
| | | | - Christopher J Miller
- VA Boston Healthcare System Center for Healthcare Organization and Implementation Research and Department of Psychiatry, Harvard Medical School, Bedford, Massachusetts, United States
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Dickmann P, Keeping S, Döring N, Schmidt AE, Binder C, Ariño-Blasco S, Gil J. Communicating the Risk of MRSA: The Role of Clinical Practice, Regulation and Other Policies in Five European Countries. Front Public Health 2017; 5:44. [PMID: 28367432 PMCID: PMC5355491 DOI: 10.3389/fpubh.2017.00044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 02/24/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The threat posed by Meticillin-resistant Staphylococcus aureus (MRSA) has taken on an increasingly pan-European dimension. This article aims to provide an overview of the different approaches to the control of MRSA adopted in five European countries (Austria, Germany, Netherlands, Spain, and the UK) and discusses data and reporting mechanisms, regulations, guidelines, and health policy approaches with a focus on risk communication. Our hypothesis is that current infection control practices in different European countries are implicit messages that contribute to the health-related risk communication and subsequently to the public perception of risk posed by MRSA. A reporting template was used to systematically collect information from each country. DISCUSSION Large variation in approaches was observed between countries. However, there were a number of consistent themes relevant to the communication of key information regarding MRSA, including misleading messages, inconsistencies in content and application of published guidelines, and frictions between the official communication and their adoption on provider level. SUMMARY The variability of recommendations within, and across, countries could be contributing to the perception of inconsistency. Having inconsistent guidelines and practices in place may also be affecting the level at which recommended behaviors are adopted. The discrepancy between the official, explicit health messages around MRSA and the implicit messages stemming from the performance of infection control measures should, therefore, be a key target for those wishing to improve risk communication.
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Affiliation(s)
- Petra Dickmann
- London School of Economics and Political Science (LSE), LSE Health, London, UK; dickmann risk communication (drc), London, UK; Department for Anaesthesiology and Critical Care Medicine, Jena University Hospital, Jena, Germany
| | - Sam Keeping
- London School of Economics and Political Science (LSE), LSE Health , London , UK
| | - Nora Döring
- Department of Health Services Research, School for Public Health and Primary Care (Caphri) of the Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Claudia Binder
- European Centre for Social Welfare Policy and Research , Vienna , Austria
| | - Sergio Ariño-Blasco
- Universitat Internacional de Catalunya Hospital General Granollers , Granollers , Spain
| | - Joan Gil
- Universitat Internacional de Catalunya Hospital General Granollers, Granollers, Spain; Department of Economics and BEAT Research Institute, University of Barcelona, Barcelona, Spain
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Cimiotti JP. Staffing level: a determinant of late-onset ventilator-associated pneumonia. Crit Care 2008; 11:154; discussion 154. [PMID: 17692135 PMCID: PMC2206520 DOI: 10.1186/cc6085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A body of knowledge exists to suggest an association between nurse staffing and adverse patient outcomes. Hugonnet and colleagues add further evidence by linking nurse staffing to late-onset ventilator-associated pneumonia. Discussed are a number of concerns surrounding the analytic component of this study, including the construction of variables and the statistical models. The authors' estimation that hospitals maintaining a nurse-to-patient ratio above 2.2 could decrease the risk of health care associated infections is based on findings that are potentially biased and unrealistic.
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Affiliation(s)
- Jeannie P Cimiotti
- University of Pennsylvania School of Nursing, Center for Health Outcomes and Policy Research, Philadelphia, Pennsylvania 19104-6096, USA
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