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International variation in length of stay in intensive care units and the impact of patient-to-nurse ratios.
Khanna, Ashish K; Labeau, Sonia O; McCartney, Kathryn; Blot, Stijn I; Deschepper, Mieke.
  • Khanna AK; Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157, USA; Outcomes Research Consortium, Cleveland 44195, OH, USA. Electronic address: akhanna@wakehealth.edu.
  • Labeau SO; School of Healthcare, Nurse Education Programme, HOGENT University of Applied Sciences and Arts, Keramiekstraat 80, 9000 Ghent, Belgium; Department of Internal Medicine & Pediatrics, Faculty of Medicine and Health Science, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium. Electronic
  • McCartney K; Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Medical Center Blvd., Winston-Salem, NC 27157, USA.
  • Blot SI; School of Healthcare, Nurse Education Programme, HOGENT University of Applied Sciences and Arts, Keramiekstraat 80, 9000 Ghent, Belgium; Department of Internal Medicine & Pediatrics, Faculty of Medicine and Health Science, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium. Electronic
  • Deschepper M; Strategic Policy Cell, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium. Electronic address: https://twitter.com/@MiekeDeschepper.
Intensive Crit Care Nurs ; 72: 103265, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-1899758
ABSTRACT

OBJECTIVE:

To assess variation in ICU length of stay between countries with varying patient-to-nurse ratios; to compare ICU length of stay of individual countries against an international benchmark.

DESIGN:

Secondary analysis of the DecubICUs trial (performed on 15 May 2018).

SETTING:

The study cohort included 12,794 adult ICU patients (57 countries). Only countries with minimally twenty patients discharged (or deceased) within 30 days of ICU admission were included. MAIN OUTCOME

MEASURE:

Multivariate Cox regression was used to evaluate ICU length of stay, censored at 30 days, across countries and for patient-to-nurse ratio, adjusted for sex, age, admission type and Simplified Acute Physiology Score II. The resulting hazard ratios for countries, indicating longer or shorter length of stay than average, were plotted on a forest plot. Results by country were benchmarked against the overall length of stay using Kaplan-Meier curves.

RESULTS:

Patients had a median ICU length of stay of 11 days (interquartile range, 4-27). Hazard ratio by country ranged from minimally 0.42 (95% confidence interval 0.35-0.51) for Greece, to maximaly1.94 (1.28-2.93) for Lithuania. The hazard ratio for patient-to-nurse was 0.96 (0.94-0.98), indicating that higher patient-to-nurse ratio results in longer length of stay.

CONCLUSIONS:

Despite adjustment for case-mix, we observed significant heterogeneity of ICU length of stay in-between countries, and a significantly longer length of stay when patient-to-nurse ratio increases. Future studies determining underlying characteristics of individual ICUs and broader organisation of healthcare infrastructure within countries may further explain the observed heterogeneity in ICU length of stay.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Discharge / Intensive Care Units Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Humans Language: English Journal: Intensive Crit Care Nurs Journal subject: Nursing / Critical Care Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Patient Discharge / Intensive Care Units Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Humans Language: English Journal: Intensive Crit Care Nurs Journal subject: Nursing / Critical Care Year: 2022 Document Type: Article