ICU nurse-to-patient ratio is associated with complications and resource use after esophagectomy.
OBJECTIVE
To determine if having a night-time nurse-to-patient ratio (NNPR) of one nurse caring for one or two patients (> 1:2) versus one nurse caring for three or more patients (< 1:2) in the intensive care unit (ICU) is associated with clinical and economic outcomes following esophageal resection.


METHODS
State-wide observational cohort study. Hospital discharge data was linked to a prospective survey of ICU organizational characteristics. Multivariate analysis adjusting for case-mix, hospital and surgeon volume was used to determine the association of NNPR with in-hospital mortality, length of stay (LOS), hospital cost and specific postoperative complications.


METHODS
Non-federal acute care hospitals (n = 35) in Maryland that performed esophageal resection.


METHODS
Adult patients who had esophageal resection in Maryland, 1994 to 1998 (n = 366 patients).


RESULTS
Two hundred twenty-five patients at nine hospitals had a NNPR > 1:2;128 patients in 23 hospitals had a NNPR < 1:2. No significant association between NNPR and in-hospital mortality was seen. A 39 % increase in median in-hospital LOS (4.3 days; 95% CI, (2, 5 days); p < 0.001), and a 32% increase in costs ($4,810; 95 % CI, ($2,094, $7,952) was associated with a NNPR < 1:2. Pneumonia (OR 2.4; 95 % CI (1.2, 4.7); p = 0.012), reintubation (OR 2.6; 95% CI(1.4, 4.5);p = 0.001), and septicemia (OR 3.6; 95 % CI(1.1, 12.5); p = 0.04), were specific complications associated with a NNPR < 1:2.


CONCLUSIONS
A nurse caring for more than two ICU patients at night increases the risk of several postoperative pulmonary and infectious complications and was associated with increased resource use in patients undergoing esophageal resection.
Department of Surgery, The Johns Hopkins School of Medicine, Baltimore, MD 21287-4685, USA.
R K
RK
Amaravadi
J B
JB
Dimick
P J
PJ
Pronovost
P A
PA
Lipsett
D000328:Adult; D016629:Esophagectomy / Q000009:adverse effects* / Q000191:economics / Q000401:mortality / Q000451:nursing*; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006302:Health Services Research; D017721:Hospital Costs / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D009551:Night Care / Q000191:economics; D015401:Nursing Administration Research; D009741:Nursing Staff, Hospital / Q000191:economics / Q000600:supply & distribution*; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling / Q000191:economics / Q000592:standards*; D011446:Prospective Studies; D012307:Risk Factors; D000078329:Workforce; D016526:Workload / Q000191:economics / Q000706:statistics & numerical data*