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Duclos A, Payet C, Baboi L, Allaouchiche B, Argaud L, Aubrun F, Bohé J, Dailler F, Fellahi JL, Lehot JJ, Piriou V, Rimmelé T, Terragrossa D, Polazzi S, Guérin C. Nurse-to-Nurse Familiarity and Mortality in the Critically Ill. A Multicenter Observational Study. Am J Respir Crit Care Med 2022; 207:1022-1029. [PMID: 36219472 DOI: 10.1164/rccm.202204-0696oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Nurse-to-nurse familiarity at work should strengthen the components of team working and enhance its efficiency. However, its impact on patient outcomes in critical care remains poorly investigated. OBJECTIVES To explore the role of nurse-to-nurse familiarity on inpatient deaths during intensive care unit stay. METHODS Retrospective observational study in eight adult academic intensive care units between 01/01/2011 and 31/12/2016. MEASUREMENTS AND MAIN RESULTS Nurse-to-nurse familiarity was measured across day and night 12-hour daily shifts as the mean number of previous collaborations between each nursing team member during previous shifts within the given Intensive Care Unit (suboptimal if<50). Primary outcome was a shift with at least one inpatient death, excluding death of patients with a decision to forego life-sustaining therapy. A multiple modified Poisson regression was computed to identify the determinants of mortality per shift, taking into account intensive care unit, patients' characteristics, patient-to-nurse and patient-to-assistant nurse ratios, nurse experience length and workload. A total of 43,479 patients were admitted of whom 3,311 (8%) died. Adjusted model showed a lower risk of a shift with mortality when nurse-to-nurse familiarity increased in the shift (relative risk 0.90 [0.82-0.98] 95%confidence intervals per 10 shifts, p=0.012). Low nurse-to-nurse familiarity during the shift combined with suboptimal patient-to-nurse and assistant-nurse ratios (suboptimal if >2.5 and >4, respectively) were associated with increased risk of shift with mortality (1.84 [1.15-2.96], p<0.001). CONCLUSIONS Shifts with low nurse-to-nurse familiarity were associated with an increased risk of patient deaths.
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Affiliation(s)
- Antoine Duclos
- University of Lyon, Lyon, Auvergne-Rhône-Alpes , France.,Hospices Civils de Lyon Pôle Information Médicale Evaluation Recherche, Lyon, Auvergne-Rhône-Alpes , France
| | - Cécile Payet
- Hospices Civils de Lyon Pole Information Medicale Evaluation Recherche, Lyon, Auvergne-Rhône-Alpes , France
| | | | - Bernard Allaouchiche
- Hospices Civils de Lyon, Pierre-Bénite, France, 1. Service de Médecine Intensive Réanimation anesthésie, lyon, France
| | - Laurent Argaud
- Groupement Hospitalier Edouard Herriot, Service de Réanimation Médicale, Lyon, France
| | - Frédéric Aubrun
- Hospices Civils de Lyon, Lyon, France, 12. Service d'Anesthésie réanimation, Hôpital de la Croix Rousse, lyon, France
| | - Julien Bohé
- Centre Hospitalier Universitaire de Lyon, Service de Réanimation, Centre Hospitalier Lyon Sud, Lyon, Rhône-Alpes , France
| | - Frédéric Dailler
- Hopital Neurologique et Neurochirurgical Pierre Wertheimer, Neurologic Intensive Care Unit, Bron, France
| | | | - Jean-Jacques Lehot
- Hospices Civils de Lyon Hopital neurologique, Anesthésie-réanimation, Lyon, France
| | - Vincent Piriou
- Centre Hospitalier Universitaire de Lyon, Service de Réanimation, Centre Hospitalier Lyon Sud, Lyon, Rhône-Alpes , France.,Universite Claude Bernard Lyon 1, HESPER EA7425, Lyon, Auvergne-Rhône-Alpes , France
| | - Thomas Rimmelé
- Edouard Herriot Hospital. Hospices Civils de Lyon. University of Lyon 1, Department of Anesthesiology and Critical Care Medicine, Lyon, France
| | - Delphine Terragrossa
- Groupement Hospitalier Nord, Médecine Intensive Réanimation, Lyon, Rhône-Alpes , France
| | - Stéphanie Polazzi
- Hospices Civils de Lyon Pole Information Medicale Evaluation Recherche, Lyon, Auvergne-Rhône-Alpes , France
| | - Claude Guérin
- Hospices civils de Lyon, Service de Médecine Intensive-Réanimation Hôpital Edouard Herriot, Lyon, France;
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