title: Changes in health service delivery for cardiac patients: implications for workforce planning and patient outcomes.
abstract: BACKGROUND
  Traditional dedicated coronary care units (CCU) are being decommissioned and cardiology precincts are evolving. These precincts often have cardiac and non-cardiac patients with a diverse array of acuity levels. Critical care trained cardiac nurses are frequently caring for lower acuity patients resulting in a deskilling of this experienced workforce.
  
  
  OBJECTIVE
  The aim of this paper was to discuss the implications of restructuring CCUs on nursing workforce and patient outcomes.
  
  
  METHODS
  An integrated literature review was conducted. The following databases were searched for articles published between January 2000 and December 2011: Ovid Medline, CINHAL, EMBASE and Cochrane. Additional studies obtained from the articles searched and policy documents from key professional organisations and government departments were reviewed.
  
  
  RESULTS
  This review has highlighted the association between workforce, qualifications and quality of care. Studies have shown the relationship between an increase in critical care qualified nursing staff and an improvement in patient outcomes. Inadequate staffing levels were also shown to be associated with an increase in adverse events. Cardiology precincts have the potential to adversely impact on critical care trained cardiac nursing workforce and patient outcomes.
  
  
  CONCLUSIONS
  The implications that these new models have on the critical care cardiac nurse workforce are crucial to health care reform, quality of in-hospital care, sentinel events and patient outcomes.
authors.affiliation: School of Nursing, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125, Australia. andrea.driscoll@deakin.edu.au
authors.forename: Andrea
authors.initials: A
authors.lastname: Driscoll
authors.forename: Judy
authors.initials: J
authors.lastname: Currey
authors.forename: Marcia
authors.initials: M
authors.lastname: George
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
mesh_terms: D003325:Coronary Care Units / Q000458:organization & administration*; D064648:Critical Care Nursing / Q000458:organization & administration; D018166:Health Care Reform; D006801:Humans; D016294:Models, Nursing; D009741:Nursing Staff, Hospital / Q000458:organization & administration* / Q000600:supply & distribution; D011787:Quality of Health Care; D000078329:Workforce