Elsevier

Heart & Lung

Volume 31, Issue 3, May–June 2002, Pages 219-228
Heart & Lung

Issues in Administration
Postoperative complications: Does intensive care unit staff nursing make a difference?*

https://doi.org/10.1067/mhl.2002.122838Get rights and content

Abstract

Objective: The purpose of this study was to examine the association between intensive care unit nurse (ICU) staffing and the likelihood of complications for patients undergoing abdominal aortic surgery. Design: The study is a retrospective review of hospital discharge data linked to data on ICU organizational characteristics. Setting: Research took place in ICUs in non-federal, short-stay hospitals in Maryland. Patients: Study included 2606 patients undergoing abdominal aortic surgery in Maryland between January 1994 and December 1996. Outcome Measures: Outcome measures included cardiac, respiratory, and other complications. Results: Cardiac complications occurred in 13% of patients, respiratory complications occurred in 30%, and other complications occurred in 8% of patients. Multiple logistic regression revealed a statistically significant increased likelihood of respiratory complications (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.50-3.60) in abdominal aortic surgery patients cared for in ICUs with low- versus high-intensity nurse staffing, an increased likelihood of cardiac complications (OR, 1.78; CI, 1.16-2.72) and other complications (OR, 1.74; CI, 1.15-2.63) in ICUs with medium- versus high-intensity nurse staffing, after controlling for patient and organizational characteristics. Conclusions: Within the range of ICU nurse staffing levels present in Maryland hospitals, decreased nurse staffing was significantly associated with an increased risk of complications in patients undergoing abdominal aortic surgery. (Heart Lung® 2002;31:219-28.)

Section snippets

Methods

This study represents a secondary analysis of hospital discharge data that were linked to a survey of organizational characteristics of ICUs. The target population of patients who had undergone abdominal aortic surgery was chosen because this surgery is a relatively common procedure performed in a variety of acute-care hospitals and typically requires care in an ICU after surgery.

Hospital sample

As summarized in Table II, 38 hospitals (83%) responded to the survey.

. Characteristics of Maryland hospitals with ICUs caring for patients who have had abdominal aortic surgery, January 1994-December 1996 (N = 38)

CharacteristicsNumber (%)
Hospital Bed size
 <24014 (37)
 241-40017 (45)
 >4007 (18)
Hospital abdominal aortic surgery volume (mean cases/year)
 >366 (16)
 <3632 (84)
Surgeon abdominal aortic surgery volume (mean cases/year)
 >814 (37)
 <824 (63)
ICU Staffed beds
 <1011 (31)
 10-1513 (36)
 16-209 (25)
 >203 (8)

Discussion

This study assessed the association between ICU staffing nurse and the likelihood of cardiac, respiratory, and other complications in patients who had had abdominal aortic surgery. The intensity of nurse staffing was significantly associated with all 3 groups of complications. This study extends other recent studies examining nurse staffing and complications11, 12, 13, 14 because it measured staffing at the unit level, included only RNs who were providing direct care, and included multiple

Limitations

Although the sample of 38 ICUs was limited to 1 state, there is no indication that ICUs in this state differ from those in other states with regards to organizational characteristics.5 Although the response rate for the survey was 83%, the nurse manager may or may not have been involved in survey completion, and responses may represent perceptions or experiences over time. Specifically, the responses to items regarding nurse staffing were likely to represent the experiences of the ICU nurse

Implications for practice and research

This study contributes to the growing evidence supporting the relationship between structural aspects of nursing care units and patient outcomes. Specifically, this study and others demonstrate that a lower proportion of RNs has consistently been associated with the development of respiratory complications.11, 12, 13, 14, 15 Nurse managers and administrators may be able to use this evidence to advocate for increased non-RN support, such as the use of respiratory therapists to moderate the risk

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    *

    Reprint requests: Deborah Dang, MS, RN, 600 N Wolfe St, Baltimore, MD 21287-1007.

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