Benbenbishty, Adult patients ratio Day and night Physical and Cross-sectional Physical restraint more Physical restraint use 3e et al., 2010 physically each shift time chemical restraint likely to be used for restrained patient ratios of use (note, results for patients who were in units (n=669) or 1:1, 1:2, 1:3 or chemical restraint with lower daytime chemically 1:4. use not reported in ratio (χ2 = 17.17, p restrained detail) = 0.001). (n=566) in 34 ICUs in nine European countries Blegen et al., Adult patients Total hours of Comparing levels In-hospital CHF Cross sectional Significant association Infection due to 4b 2011 (approx. 1.1 care from between mortality, decubitus between infection due to medical care, million) in 54 US RN/LPN/NA per hospitals - no ulcer, failure to medical care and total ICU postoperative sepsis, hospitals, staffing patient day and specific rescue, infection due staffing and between ICU in-hospital CHF data from 285 skill mix (RN comparator to medical care, RN skill mix and mortality, failure to ICUs, 587 general percent) postoperative sepsis, postoperative sepsis in rescue wards, outcomes rate of LOS > non-safety-net hospitals. measured at expected Significant associations hospital level between CHF mortality and failure to rescue and ICU RN skill mix in hospitals Blot et al., 2011 Adult ICU patients Patient-to-nurse Staffing level Prospective, No significant difference in None 3e (n=1658) treated ratio ratios: Model I observational VAP rates in ICUs with for pneumonia or (1:1, 2:1, 2.5:2, & pneumonia (VAP) survey patient-to-nurse ratio of receiving invasive 3:1); Model II (1:1 2:1 or > 2:1. A 1:1 mechanical & >1:1); Model III ratio was ventilation 48 (2:1 & >2:1); associated with lower risk ≥ hours in 27 ICUs Model IV (<3:1 for VAP but not significant in 9 European and 3:1). after adjustment for countries. confounding covariates. Non-significant association between higher nurse staffing levels and reduced risk for late-onset VAP.
Benbenbishty, et al., 2010 Adult patients physically restrained (n=669) or chemically restrained (n=566) in 34 ICUs in nine European countries ratio each shift Day and night time patient ratios of 1:1, 1:2, 1:3 or 1:4. Physical and chemical restraint use (note, results for chemical restraint use not reported in detail) Cross-sectional Physical restraint more likely to be used for patients who were in units with lower daytime ratio (χ2 = 17.17, p = 0.001). Physical restraint use 3e Blegen et al., 2011 Adult patients (approx. 1.1 million) in 54 US hospitals, staffing data from 285 ICUs, 587 general wards, outcomes measured at hospital level Total hours of care from RN/LPN/NA per patient day and skill mix (RN percent) Comparing levels between hospitals - no specific comparator In-hospital CHF mortality, decubitus ulcer, failure to rescue, infection due to medical care, postoperative sepsis, rate of LOS > expected Cross sectional Significant association between infection due to medical care and total ICU staffing and between ICU RN skill mix and postoperative sepsis in non-safety-net hospitals. Significant associations between CHF mortality and failure to rescue and ICU RN skill mix in hospitals Infection due to medical care, postoperative sepsis, in-hospital CHF mortality, failure to rescue 4b Blot et al., 2011 Adult ICU patients (n=1658) treated for pneumonia or receiving invasive mechanical ventilation ≥ 48 hours in 27 ICUs in 9 European countries. Patient-to-nurse ratio Staffing level ratios: Model I (1:1, 2:1, 2.5:2, & 3:1); Model II (1:1 & >1:1); Model III (2:1 & >2:1); Model IV (<3:1 and 3:1). pneumonia (VAP) Prospective, observational survey No significant difference in VAP rates in ICUs with patient-to-nurse ratio of 2:1 or > 2:1. A 1:1 ratio was associated with lower risk for VAP but not significant after adjustment for confounding covariates. Non-significant association between higher nurse staffing levels and reduced risk for late-onset VAP. None 3e
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