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October 18, 2001
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"Hospital administrators who reduce the number of ICU nurses in order to cut costs may actually cost themselves more in the long run." – Peter J. Pronovost, M.D., Ph.D.
Patients undergoing high-risk surgeries are more likely to have post-operative
complications, including difficulty breathing, if their hospital's intensive
care unit (ICU) isn't sufficiently staffed by nurses, according to a Johns Hopkins
study of Maryland hospitals.
Results of the study, published in the October issue of Effective Clinical
Practice, a journal of the American College of Physicians, indicate that while
the optimal nurse-to-patient ratio remains to be determined, intensive care
units having ratios of one nurse for every three or four patients, rather than
one or two, have significantly higher rates of post-surgical complications.
Overall, 47 percent of patients treated in hospitals with fewer ICU nurses
and 34 percent treated in hospitals with more ICU nurses had at least one complication.
Patients treated in hospitals with fewer ICU nurses were more likely to have
medical complications (43 percent vs. 28 percent) or respiratory failure (21
percent vs. 13 percent), or need a breathing tube re-inserted (21 percent vs.
13 percent). Nurse staffing did not affect the risk for surgical complications.
"Nurses who care for three or more patients may have less time to devote
to patient care – especially preventive measures, such as post-operative
pulmonary care," says Peter J. Pronovost, M.D., Ph.D., lead author of the
study and associate professor of anesthesiology and critical care medicine.
"Hospital administrators who reduce the number of ICU nurses in order to
cut costs may actually cost themselves more in the long run."
For the study, researchers analyzed hospital discharge data for 2,606 abdominal
aortic aneurysm patients who were treated at 38 hospitals in Maryland between
1994 and 1996, looking at medical and surgical complications such as pulmonary
problems, kidney failure, heart complications, bloodstream infection and post-operative
bleeding. People with abdominal aneurysm -- a dangerous ballooning of a major
blood vessel in the abdomen -- routinely require ICU admission because of high
post-operative morbidity and mortality. The authors also surveyed 39 local ICU
medical directors and nursing directors about their ICU staffing, including
the nurse-to-patient ratio during the day and evening. Seven hospitals with
a total 478 patients had fewer ICU nurses, compared with 31 hospitals with a
total 2,128 patients that had more.
The study's other authors were Deborah Dang, M.S.N.; Todd Dorman, M.D.; Pamela
A. Lipsett, M.D.; Elizabeth Garrett, Ph.D.; Mollie Jenckes, M.Sc.; and Eric
B. Bass, M.D., M.P.H.
Pronovost, P.J., et al., "Intensive Care Unit Nurse Staffing and the Risk for Complications after Abdominal Aortic Surgery," Effective Clinical Practice, 2001; 4:199-206.
Related Web sites:
Johns Hopkins Department of Anesthesiology and Critical Care Medicine
http://www.med.jhu.edu/anesthesiology/
American College of Physicians
http://www.acponline.org