News Release

Staff workload risk factor for infant death intensive care

Peer-Reviewed Publication

The Lancet_DELETED

N.B. Please note that if you are outside North America the embargo date for Lancet Press Material is 0001 hours UK Time Friday 11 January 2002.

A comprehensive study of UK neonatal intensive-care units (NICUs) in this week’s issue of THE LANCET highlights how high staff workloads pose a threat to the outcome of infants in intensive care.

UK recommendations suggest that large NICUs perform better than small units, but this suggestion remains unproven. Janet Tucker from the University of Aberdeen, UK, and colleagues from the UK Neonatal Staffing Study Group assessed whether patient volume, staffing levels, and workload were associated with risk-adjusted outcomes, and with costs or staff wellbeing.

186 UK NICUs were categorised according to volume of patients, proportion of nursing provision, and neonatal consultant provision. The primary outcome measures were death in hospital, death or cerebral damage, and nosocomial bacteraemia (hospital-based bacterial infection). Around 13,500 infants admitted to 54 randomly selected NICUs were studied.

High-volume NICUs treated the sickest infants and had highest crude death-rates; however, after adjustment for initial clinical risk and illness severity, patient volume and staffing provision did not influence mortality or cerebral-damage outcomes. Nosocomial bacteraemia was less frequent in NICUs with low neonatal consultant provision. Increasing workload was a risk factor for mortality across all NICUs; infants admitted at full capacity compared with half capacity were about 50% more likely to die.

In an accompanying Commentary (p 95), Murray Pollack and Kantilal Patel from George Washington University School of Medicine, USA, are enthusiastic about many aspects of the UK Neonatal Staffing Study Group’s research. However, they caution that new measures are required to fully understand the complex nature of NICUs. They comment: “Things have moved on since the Neonatal Staffing Study was started. Factors such as volume of patients and total staff numbers no longer adequately represent what is really happening at the bedside. The details of delivery of care can be examined, and organisational and bedside management factors as well as clinical factors that are associated with clinical outcomes are starting to be understood…ICUs have been leaders in research into quality of care, in part because mortality is both easy to measure and is a relevant outcome, and in part because there is a strong association between physiological variables and mortality, enabling good case-mix adjustment. Now the major challenge in research into quality of care in ICUs is to focus on the influence of bedside care rather than on broadly defined factors related to quality.”

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Contact: Dr Janet Tucker, Dugald Baird Centre for Research on Womens Health, Department of Obstetrics and Gynaecology, University of Aberdeen, Cornhill Road, Aberdeen, Scotland AB25 2ZL, UK; T) +44 (0)1224 563875; F) +44 (0)1224 404925; E) j.s.tucker@abdn.ac.uk

Professor Murray Pollack, George Washington University School of Medicine, Washington, DC, USA; E) mpollack@cnmc.org


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