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Outcomes sensitive to critical care nurse staffing levels: a systematic review

Outcomes sensitive to critical care nurse staffing levels: a systematic review
Outcomes sensitive to critical care nurse staffing levels: a systematic review
Objective: to determine associations between variations in registered nurse staffing levels in adult critical care units and outcomes such as patient, nurse, organisational and family outcomes.
Methods: we published and adhered to a protocol, stored in an open access repository and searched for quantitative studies written in the English language and held in CINAHL Plus, MEDLINE, PsycINFO, SCOPUS and NDLTD databases up to July 2020. Three authors independently extracted data and critically appraised papers meeting the inclusion criteria. Results are summarised in tables and discussed in terms of strength of internal validity. A detailed review of the two most commonly measured outcomes, patient mortality and nosocomial infection, is also presented.
Results: our search returned 7,960 titles after duplicates were removed; 55 studies met the inclusion criteria. Studies with strong internal validity report significant associations between lower levels of critical care nurse staffing and increased odds of both patient mortality (1.24 to 3.50 times greater) and nosocomial infection (3.28 to 3.60 times greater), increased hospital costs, lower nurse-perceived quality of care and lower family satisfaction. Meta-analysis was not feasible because of the wide variation in how both staffing and outcomes were measured.
Conclusions: a large number of studies including several with high internal validity provide evidence that higher levels of critical care nurse staffing are beneficial to patients, staff and health services. However, inconsistent approaches to measurement and aggregation of staffing levels reported makes it hard to translate findings into recommendation for safe staffing in critical care.
Critical care, Cross infection, Health care, Health workforce, Mortality, Outcome assessment, Registered nurse
0964-3397
Rae, Pamela J L
08700051-d61f-4fa4-ab48-59e10e1a0376
Pearce, Susie
efc04ece-af26-452f-9e81-c610ded64b8d
Greaves, Jane
cd651ba7-e523-4882-a576-d2feedf3c4fe
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Dall'ora, Chiara
4501b172-005c-4fad-86da-2d63978ffdfd
Endacott, Ruth
f50a0a28-b482-40da-9a01-89652eecfcfa
Rae, Pamela J L
08700051-d61f-4fa4-ab48-59e10e1a0376
Pearce, Susie
efc04ece-af26-452f-9e81-c610ded64b8d
Greaves, Jane
cd651ba7-e523-4882-a576-d2feedf3c4fe
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Dall'ora, Chiara
4501b172-005c-4fad-86da-2d63978ffdfd
Endacott, Ruth
f50a0a28-b482-40da-9a01-89652eecfcfa

Rae, Pamela J L, Pearce, Susie, Greaves, Jane, Griffiths, Peter, Dall'ora, Chiara and Endacott, Ruth (2021) Outcomes sensitive to critical care nurse staffing levels: a systematic review. Intensive and Critical Care Nursing, 67, [103110]. (doi:10.1016/j.iccn.2021.103110).

Record type: Article

Abstract

Objective: to determine associations between variations in registered nurse staffing levels in adult critical care units and outcomes such as patient, nurse, organisational and family outcomes.
Methods: we published and adhered to a protocol, stored in an open access repository and searched for quantitative studies written in the English language and held in CINAHL Plus, MEDLINE, PsycINFO, SCOPUS and NDLTD databases up to July 2020. Three authors independently extracted data and critically appraised papers meeting the inclusion criteria. Results are summarised in tables and discussed in terms of strength of internal validity. A detailed review of the two most commonly measured outcomes, patient mortality and nosocomial infection, is also presented.
Results: our search returned 7,960 titles after duplicates were removed; 55 studies met the inclusion criteria. Studies with strong internal validity report significant associations between lower levels of critical care nurse staffing and increased odds of both patient mortality (1.24 to 3.50 times greater) and nosocomial infection (3.28 to 3.60 times greater), increased hospital costs, lower nurse-perceived quality of care and lower family satisfaction. Meta-analysis was not feasible because of the wide variation in how both staffing and outcomes were measured.
Conclusions: a large number of studies including several with high internal validity provide evidence that higher levels of critical care nurse staffing are beneficial to patients, staff and health services. However, inconsistent approaches to measurement and aggregation of staffing levels reported makes it hard to translate findings into recommendation for safe staffing in critical care.

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Rae et al SR ICCN - reviewed_ edited_ accepted manuscript - Accepted Manuscript
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More information

Accepted/In Press date: 4 June 2021
Published date: 9 July 2021
Additional Information: This paper presents independent research funded by the National Institute for Health Research (Programme Development Grants, Safe staffing in ICU: development and testing of a staffing model, NIHR200100). The views expressed in this publication are those of the author(s) and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care, neither of whom have had involvement in any aspect of the design, data collection, synthesis, interpretation or writing of, this review.
Keywords: Critical care, Cross infection, Health care, Health workforce, Mortality, Outcome assessment, Registered nurse

Identifiers

Local EPrints ID: 449851
URI: http://eprints.soton.ac.uk/id/eprint/449851
ISSN: 0964-3397
PURE UUID: 5f8582c5-474e-406b-8f53-d28f8f9db818
ORCID for Peter Griffiths: ORCID iD orcid.org/0000-0003-2439-2857
ORCID for Chiara Dall'ora: ORCID iD orcid.org/0000-0002-6858-3535

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Date deposited: 22 Jun 2021 16:31
Last modified: 12 Apr 2022 01:51

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Contributors

Author: Pamela J L Rae
Author: Susie Pearce
Author: Jane Greaves
Author: Peter Griffiths ORCID iD
Author: Chiara Dall'ora ORCID iD
Author: Ruth Endacott

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