New cardiac models of care reduce patient access to specialist nurses: a Victorian cross-sectional pilot study.
BACKGROUND
Several studies have shown that the acuity and complexity of patients admitted to coronary care units is rising. Advances in medical technology and management of these patients have resulted in shorter lengths of hospital stay. Together, these changing care patterns have led to an emergence of new models of care delivery that differ from traditional coronary care units (CCU). The effect of these new models on workforce and resources in this area is unknown.


OBJECTIVE
To describe the workforce and workplace resources of adult CCUs in Victoria, Australia.


METHODS
This pilot study used an investigator-developed survey to audit all adult CCUs operating in Victoria in 2010.


RESULTS
A total of 24 CCUs participated in the audit of which the majority were located in metropolitan public hospitals. In terms of model of care of CCUs: 25% (6) of CCUs were a combination of a CCU/cardiology ward, 17% (4) a combined CCU/ICU or combined CCU/ICU/HDU and 12.5% (3) of CCUs were a dedicated unit. Only 15% (4) of all units met the international standards for a nursing workforce with critical care qualifications. The CCU/day procedure/HDU models had 24% of critical care qualified staff followed by CCU/cardiology ward model with 35% compared to an average of 54-80% of qualified staff in the other models of care of CCU.


CONCLUSIONS
This pilot study has highlighted the heterogeneity in models of CCU and a shortage of qualified critical care nurses, particularly in the CCU/cardiology ward model. This may have implications for the quality of care delivered in CCUs.
School of Nursing and Midwifery, Deakin University, Burwood Highway, Burwood, Victoria, Australia. Electronic address: andrea.driscoll@deakin.edu.au.
Andrea
A
Driscoll
School of Nursing and Midwifery, Deakin University, Burwood Highway, Burwood, Victoria, Australia. Electronic address: judy.currey@deakin.edu.au.
Judy
J
Currey
School of Nursing and Midwifery, Deakin University, Burwood Highway, Burwood, Victoria, Australia. Electronic address: josh.allen@deakin.edu.au.
Joshua A
JA
Allen
ISIS Primary Care Limited, 106 Station Road, Deer Park 3023, Victoria, Australia. Electronic address: marcia.george@isispc.com.au.
Marcia
M
George
University of Technology Sydney, Sydney, Australia. Electronic address: patriciamary.davidson@uts.edu.au.
Patricia M
PM
Davidson
D064646:Cardiovascular Nursing / Q000458:organization & administration / Q000706:statistics & numerical data*; D003325:Coronary Care Units / Q000458:organization & administration*; D064648:Critical Care Nursing / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D006801:Humans; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D010865:Pilot Projects; D014739:Victoria; D000078329:Workforce; D016526:Workload
Coronary care unit; Critical care; Model of care; Workforce planning