Tarnow-Mordi Adult medical and ICU workload Overall ICU In-hospital mortality Retrospective Adjusted mortality was In-hospital mortality 3e et al., 2000 surgical patients measured by workload during analysis from related to (i) ratio of (n=1,025) occupancy, ratio stay categorised prospective occupied to appropriately admitted to an of occupied to as moderate, cohort study staffed beds per shift and ICU in a hospital appropriately intermediate, and (ii) peak occupancy. in Scotland staffed beds, and high (composite nursing measure of requirement per average nursing shift requirement per occupied bed per shift and peak occupancy in any shift in the stay). van den Heede patients No specific Modelled the in-hospital mortality Observational No significant association None 3e et al., 2009 (n=9054) intervention - outcome to study between ICU staffing admitted to 28 calculated NHPPD consider the levels and mortality Belgian acute for each nursing result if all units care hospitals for unit increased their a CABG or heart staffing to the valve procedure. 75th percentile van der Kooi et Adult patients Nurse to patient Nurse to patient Restraint use Cross-sectional No significant relationship None 4b al. 2015 (n=379) admitted ratio 1 to 1 ratio >1 to 1 between restraint use and ≤ to 25 ICUs in 25 to patient ratio hospitals in the Netherlands West et al., Adult patients Number of FTE Lower number of Mortality (in-hospital Observational Significant relationship ICU mortality and 3e 2014 (n=38,168) permanent direct FTE permanent and in-ICU) between number of direct mortality admitted to 65 care registered direct care RNs care nurses per bed and ICUs in England nurses (RNs) and ICU mortality; OR 0.90 health care (0.84, 0.97) and hospital assistants mortality; OR 0.92 (0.87, 0.98).
Tarnow-Mordi et al., 2000 Adult medical and surgical patients (n=1,025) admitted to an ICU in a hospital in Scotland ICU workload measured by occupancy, ratio of occupied to appropriately staffed beds, and nursing requirement per shift Overall ICU workload during stay categorised as moderate, intermediate, and high (composite measure of average nursing requirement per occupied bed per shift and peak occupancy in any shift in the stay). In-hospital mortality Retrospective analysis from prospective cohort study Adjusted mortality was related to (i) ratio of occupied to appropriately staffed beds per shift and (ii) peak occupancy. In-hospital mortality 3e van den Heede et al., 2009 patients (n=9054) admitted to 28 Belgian acute care hospitals for a CABG or heart valve procedure. No specific intervention - calculated NHPPD for each nursing unit Modelled the outcome to consider the result if all units increased their staffing to the 75th percentile in-hospital mortality Observational study No significant association between ICU staffing levels and mortality None 3e van der Kooi et al. 2015 Adult patients (n=379) admitted to 25 ICUs in 25 hospitals in the Netherlands Nurse to patient ratio ≤ 1 to 1 Nurse to patient ratio >1 to 1 Restraint use Cross-sectional No significant relationship between restraint use and to patient ratio None 4b West et al., 2014 Adult patients (n=38,168) admitted to 65 ICUs in England Number of FTE permanent direct care registered nurses (RNs) and health care assistants Lower number of FTE permanent direct care RNs Mortality (in-hospital and in-ICU) Observational Significant relationship between number of direct care nurses per bed and ICU mortality; OR 0.90 (0.84, 0.97) and hospital mortality; OR 0.92 (0.87, 0.98). ICU mortality and mortality 3e
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