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DOI: 10.1055/s-0035-1570350
Who Should Be at the Bedside 24/7: Doctors, Families, Nurses?
Publikationsverlauf
Publikationsdatum:
28. Januar 2016 (online)
![](https://www.thieme-connect.de/media/srccm/201601/lookinside/thumbnails/10-1055-s-0035-1570350_01183-1.jpg)
Abstract
Critical illness does not keep to regular, daytime business hours; we must provide high-quality care and support for intensive care unit (ICU) patients 24 hours per day, 7 days per week. Whether this mandates the presence of similar numbers and types of personnel throughout all hours of the day, however, has been the subject of much debate and substantial research. In this article, we review the available literature on the consequences of having three groups of care providers at a patient's bedside overnight: physicians, visitors, and nurses. Though few of the studies on this topic are randomized and prospective, several themes have emerged from the existing data. First, there is dramatic variation in practice between and within countries. Second, the weight of evidence does not indicate that patient outcomes are improved by having an intensivist present overnight in ICUs that are staffed by intensivists during the daytime hours. Third, although visitation is highly restricted in many ICUs—out of concerns for disruption of care and a negative physiological or psychological impact on patients—the available data suggest that patients and their families generally benefit from open visitation policies. And finally, although there is little debate that nurses are (and should be) available in the ICU 24/7, existing data do not provide much of a consensus about the details. Uncertainties include whether outcomes are better when each nurse is assigned only one patient (or, more generally, the optimal patient:nurse ratio), who these nurses should be (e.g., registered nurses vs. other personnel), and what their roles should entail (e.g., managing ventilators). As such, we cannot yet identify the optimal overnight nurse staffing strategy. What is clear is that the critical care community needs more and better data to further define these aspects of the relationship between ICU structure and ICU outcomes.
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References
- 1 Cavallazzi R, Marik PE, Hirani A, Pachinburavan M, Vasu TS, Leiby BE. Association between time of admission to the ICU and mortality: a systematic review and metaanalysis. Chest 2010; 138 (1) 68-75
- 2 Bhonagiri D, Pilcher DV, Bailey MJ. Increased mortality associated with after-hours and weekend admission to the intensive care unit: a retrospective analysis. Med J Aust 2011; 194 (6) 287-292
- 3 Rubenfeld GD. The Structure of Intensive Care: If You've Seen One ICU, You've Seen One ICU. Critical Care Alert: Thomson American Health Consultants; 2000
- 4 Graf J, Reinhold A, Brunkhorst FM , et al; German Competence Network Sepsis (SepNet). Variability of structures in German intensive care units—a representative, nationwide analysis. Wien Klin Wochenschr 2010; 122 (19–20) 572-578
- 5 Wilcox ME, Harrison DA, Short A, Jonas M, Rowan KM. Comparing mortality among adult, general intensive care units in England with varying intensivist cover patterns: a retrospective cohort study. Crit Care 2014; 18 (4) 491
- 6 Angus DC, Shorr AF, White A, Dremsizov TT, Schmitz RJ, Kelley MA. Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS). Critical care delivery in the United States: distribution of services and compliance with Leapfrog recommendations. Crit Care Med 2006; 34 (4) 1016-1024
- 7 Hyzy RC, Flanders SA, Pronovost PJ , et al. Characteristics of intensive care units in Michigan: not an open and closed case. J Hosp Med 2010; 5 (1) 4-9
- 8 Parshuram CS, Kirpalani H, Mehta S, Granton J, Cook D. Canadian Critical Care Trials Group. In-house, overnight physician staffing: a cross-sectional survey of Canadian adult and pediatric intensive care units. Crit Care Med 2006; 34 (6) 1674-1678
- 9 Chittawatanarat K, Bhurayanontachai R, Thongchai C. Thai Society of Critical Care Medicine Study Group. Characters of physician and nurse staffing in Thai intensive care units (ICU-Resource I study). J Med Assoc Thai 2014; 97 (Suppl. 01) S38-S44
- 10 Bell R, Robinson L. Final Report of the Ontario Critical Care Steering Committee March 2005. Toronto: Ontario Ministry of Health and Long-term Care; 2005
- 11 Brilli RJ, Spevetz A, Branson RD , et al; American College of Critical Care Medicine Task Force on Models of Critical Care Delivery. The American College of Critical Care Medicine Guidelines for the Definition of an Intensivist and the Practice of Critical Care Medicine. Critical care delivery in the intensive care unit: defining clinical roles and the best practice model. Crit Care Med 2001; 29 (10) 2007-2019
- 12 Bellomo R, Stow PJ, Hart GK. Why is there such a difference in outcome between Australian intensive care units and others?. Curr Opin Anaesthesiol 2007; 20 (2) 100-105
- 13 Angus DC, Kelley MA, Schmitz RJ, White A, Popovich Jr J. Committee on Manpower for Pulmonary and Critical Care Societies (COMPACCS). Caring for the critically ill patient. Current and projected workforce requirements for care of the critically ill and patients with pulmonary disease: can we meet the requirements of an aging population?. JAMA 2000; 284 (21) 2762-2770
- 14 Haupt MT, Bekes CE, Brilli RJ , et al; Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine. Guidelines on critical care services and personnel: recommendations based on a system of categorization of three levels of care. Crit Care Med 2003; 31 (11) 2677-2683
- 15 The Leapfrog Group. ICU Physician Staffing. [cited 2015 July 17]. Available at: http://www.leapfroggroup.org/media/file/Leapfrog-ICU_Physician_Staffing_Fact_Sheet.pdf
- 16 Azoulay E, Mancebo J, Brochard L. Surviving the night in the ICU: who needs senior intensivists?. Am J Respir Crit Care Med 2010; 182 (3) 293-294
- 17 Blunt MC, Burchett KR. Out-of-hours consultant cover and case-mix-adjusted mortality in intensive care. Lancet 2000; 356 (9231) 735-736
- 18 Gajic O, Afessa B, Hanson AC , et al. Effect of 24-hour mandatory versus on-demand critical care specialist presence on quality of care and family and provider satisfaction in the intensive care unit of a teaching hospital. Crit Care Med 2008; 36 (1) 36-44
- 19 Wallace DJ, Angus DC, Barnato AE, Kramer AA, Kahn JM. Nighttime intensivist staffing and mortality among critically ill patients. N Engl J Med 2012; 366 (22) 2093-2101
- 20 Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA 2002; 288 (17) 2151-2162
- 21 Kerlin MP, Harhay MO, Kahn JM, Halpern SD. Nighttime intensivist staffing, mortality, and limits on life support: a retrospective cohort study. Chest 2015; 147 (4) 951-958
- 22 Wilcox ME, Chong CAKY, Niven DJ , et al. Do intensivist staffing patterns influence hospital mortality following ICU admission? A systematic review and meta-analyses. Crit Care Med 2013; 41 (10) 2253-2274
- 23 Garland A, Roberts D, Graff L. Twenty-four-hour intensivist presence: a pilot study of effects on intensive care unit patients, families, doctors, and nurses. Am J Respir Crit Care Med 2012; 185 (7) 738-743
- 24 Kerlin MP, Small DS, Cooney E , et al. A randomized trial of nighttime physician staffing in an intensive care unit. N Engl J Med 2013; 368 (23) 2201-2209
- 25 Abbott KH, Sago JG, Breen CM, Abernethy AP, Tulsky JA. Families looking back: one year after discussion of withdrawal or withholding of life-sustaining support. Crit Care Med 2001; 29 (1) 197-201
- 26 Cantor JC, Blustein J, Carlson MJ, Gould DA. Next-of-kin perceptions of physician responsiveness to symptoms of hospitalized patients near death. J Palliat Med 2003; 6 (4) 531-541
- 27 [Anonymous] Patient Safety Primers–Rapid Response Systems October 2012 [cited 2015 August 29]. Available at: http://psnet.ahrq.gov/primer.aspx?primerID=4
- 28 Winters BD, Weaver SJ, Pfoh ER, Yang T, Pham JC, Dy SM. Rapid-response systems as a patient safety strategy: a systematic review. Ann Intern Med 2013; 158 (5, Pt 2) 417-425
- 29 McNeill G, Bryden D. Do either early warning systems or emergency response teams improve hospital patient survival? A systematic review. Resuscitation 2013; 84 (12) 1652-1667
- 30 McGaughey J, Alderdice F, Fowler R, Kapila A, Mayhew A, Moutray M. Outreach and Early Warning Systems (EWS) for the prevention of intensive care admission and death of critically ill adult patients on general hospital wards. Cochrane Database Syst Rev 2007; (3) CD005529
- 31 Laurens NH, Dwyer TA. The effect of medical emergency teams on patient outcome: a review of the literature. Int J Nurs Pract 2010; 16 (6) 533-544
- 32 Jones D, Baldwin I, McIntyre T , et al. Nurses' attitudes to a medical emergency team service in a teaching hospital. Qual Saf Health Care 2006; 15 (6) 427-432
- 33 Bagshaw SM, Mondor EE, Scouten C , et al; Capital Health Medical Emergency Team Investigators. A survey of nurses' beliefs about the medical emergency team system in a Canadian tertiary hospital. Am J Crit Care 2010; 19 (1) 74-83
- 34 Rothberg MB, Belforti R, Fitzgerald J, Friderici J, Keyes M. Four years' experience with a hospitalist-led medical emergency team: an interrupted time series. J Hosp Med 2012; 7 (2) 98-103
- 35 Repasky TM, Pfeil C. Experienced critical care nurse-led rapid response teams rescue patients on in-patient units. J Emerg Nurs 2005; 31 (4) 376-379
- 36 Morris DS, Schweickert W, Holena D , et al. Differences in outcomes between ICU attending and senior resident physician led medical emergency team responses. Resuscitation 2012; 83 (12) 1434-1437
- 37 Smith CC, Gordon CE, Feller-Kopman D , et al. Creation of an innovative inpatient medical procedure service and a method to evaluate house staff competency. J Gen Intern Med 2004; 19 (5, Pt 2) 510-513
- 38 Silverberg MJ, Kory P. Survey of video laryngoscopy use by U.S. critical care fellowship training programs. Ann Am Thorac Soc 2014; 11 (8) 1225-1229
- 39 [Anonymous] The Critical Care Workforce: A Study of the Supply and Demand for Critical Care Physicians. 2003 November 24, 2014 [cited 2015 August 29]. Available at: http://bhpr.hrsa.gov/healthworkforce/reports/studycriticalcarephys.pdf
- 40 Kahn JM, Rubenfeld GD. The myth of the workforce crisis. Why the United States does not need more intensivist physicians. Am J Respir Crit Care Med 2015; 191 (2) 128-134
- 41 MacDowell M, Glasser M, Fitts M, Nielsen K, Hunsaker M. A national view of rural health workforce issues in the USA. Rural Remote Health 2010; 10 (3) 1531
- 42 Pong RW, Pitblado JR. Geographic Distribution of Physicians in Canada: Beyond How Many and Where. 2005 [cited 2015 September 2]. Available at: https://secure.cihi.ca/free_products/Geographic_Distribution_of_Physicians_FINAL_e.pdf
- 43 Lee DM, Nichols T. Physician recruitment and retention in rural and underserved areas. Int J Health Care Qual Assur 2014; 27 (7) 642-652
- 44 Breslow MJ. Remote ICU care programs: current status. J Crit Care 2007; 22 (1) 66-76
- 45 Lilly CM, Zubrow MT, Kempner KM , et al. Critical care telemedicine: evolution and state of the art. Crit Care Med 2014; 42 (11) 2429-2436
- 46 Kahn JM, Cicero BD, Wallace DJ, Iwashyna TJ. Adoption of ICU telemedicine in the United States. Crit Care Med 2014; 42 (2) 362-368
- 47 Young LB, Chan PS, Lu X, Nallamothu BK, Sasson C, Cram PM. Impact of telemedicine intensive care unit coverage on patient outcomes: a systematic review and meta-analysis. Arch Intern Med 2011; 171 (6) 498-506
- 48 Sucher JF, Todd SR, Jones SL, Throckmorton T, Turner KL, Moore FA. Robotic telepresence: a helpful adjunct that is viewed favorably by critically ill surgical patients. Am J Surg 2011; 202 (6) 843-847
- 49 [Anonymous] Innovative ICU Care to Debut in Central Indiana. 2004 [cited 2015 September 2]. Available at: http://www.businesswire.com/news/home/20040716005282/en/Innovative-ICU-Care-Debut-Central-Indiana.Ve4KuJcTseE
- 50 Kruklitis RJ, Tracy JA, McCambridge MM. Clinical and financial considerations for implementing an ICU telemedicine program. Chest 2014; 145 (6) 1392-1396
- 51 Kumar G, Falk DM, Bonello RS, Kahn JM, Perencevich E, Cram P. The costs of critical care telemedicine programs: a systematic review and analysis. Chest 2013; 143 (1) 19-29
- 52 Lilly CM, McLaughlin JM, Zhao H, Baker SP, Cody S, Irwin RS. UMass Memorial Critical Care Operations Group. A multicenter study of ICU telemedicine reengineering of adult critical care. Chest 2014; 145 (3) 500-507
- 53 Nassar BS, Vaughan-Sarrazin MS, Jiang L, Reisinger HS, Bonello R, Cram P. Impact of an intensive care unit telemedicine program on patient outcomes in an integrated health care system. JAMA Intern Med 2014; 174 (7) 1160-1167
- 54 Giannini A. Open intensive care units: the case in favour. Minerva Anestesiol 2007; 73 (5) 299-305
- 55 Molter NC. Needs of relatives of critically ill patients: a descriptive study. Heart Lung 1979; 8 (2) 332-339
- 56 Youngner SJ, Coulton C, Welton R, Juknialis B, Jackson DL. ICU visiting policies. Crit Care Med 1984; 12 (7) 606-608
- 57 Woellner DS. Flexible visiting hours in the adult critical care unit. Focus Crit Care 1988; 15 (2) 66-69
- 58 Barnato AE, Kahn JM, Rubenfeld GD , et al. Prioritizing the organization and management of intensive care services in the United States: the PrOMIS Conference. Crit Care Med 2007; 35 (4) 1003-1011
- 59 Truog RD, Campbell ML, Curtis JR , et al; American Academy of Critical Care Medicine. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College [corrected] of Critical Care Medicine. Crit Care Med 2008; 36 (3) 953-963
- 60 Davidson JE, Powers K, Hedayat KM , et al; American College of Critical Care Medicine Task Force 2004-2005, Society of Critical Care Medicine. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Med 2007; 35 (2) 605-622
- 61 Berwick DM, Kotagal M. Restricted visiting hours in ICUs: time to change. JAMA 2004; 292 (6) 736-737
- 62 Vandijck DM, Labeau SO, Geerinckx CE , et al; Executive Board of the Flemish Society for Critical Care Nurses, Ghent and Edegem, Belgium. An evaluation of family-centered care services and organization of visiting policies in Belgian intensive care units: a multicenter survey. Heart Lung 2010; 39 (2) 137-146
- 63 Berti D, Ferdinande P, Moons P. Beliefs and attitudes of intensive care nurses toward visits and open visiting policy. Intensive Care Med 2007; 33 (6) 1060-1065
- 64 Spreen AE, Schuurmans MJ. Visiting policies in the adult intensive care units: a complete survey of Dutch ICUs. Intensive Crit Care Nurs 2011; 27 (1) 27-30
- 65 Quinio P, Savry C, Deghelt A, Guilloux M, Catineau J, de Tinténiac A. A multicenter survey of visiting policies in French intensive care units. Intensive Care Med 2002; 28 (10) 1389-1394
- 66 Giannini A, Miccinesi G, Leoncino S. Visiting policies in Italian intensive care units: a nationwide survey. Intensive Care Med 2008; 34 (7) 1256-1262
- 67 Hunter JD, Goddard C, Rothwell M, Ketharaju S, Cooper H. A survey of intensive care unit visiting policies in the United Kingdom. Anaesthesia 2010; 65 (11) 1101-1105
- 68 Knutsson SE, Otterberg CL, Bergbom IL. Visits of children to patients being cared for in adult ICUs: policies, guidelines and recommendations. Intensive Crit Care Nurs 2004; 20 (5) 264-274
- 69 Liu V, Read JL, Scruth E, Cheng E. Visitation policies and practices in US ICUs. Crit Care 2013; 17 (2) R71-R71
- 70 Lee MD, Friedenberg AS, Mukpo DH, Conray K, Palmisciano A, Levy MM. Visiting hours policies in New England intensive care units: strategies for improvement. Crit Care Med 2007; 35 (2) 497-501
- 71 Simpson T, Shaver J. Cardiovascular responses to family visits in coronary care unit patients. Heart Lung 1990; 19 (4) 344-351
- 72 Kleman M, Bickert A, Karpinski A , et al. Physiologic responses of coronary care patients to visiting. J Cardiovasc Nurs 1993; 7 (3) 52-62
- 73 Schulte DA, Burrell LO, Gueldner SH , et al. Pilot study of the relationship between heart rate and ectopy and unrestricted vs restricted visiting hours in the coronary care unit. Am J Crit Care 1993; 2 (2) 134-136
- 74 Yousefi H, Naderi M, Daryabeigi R. The effect of sensory stimulation provided by family on arterial blood oxygen saturation in critical care patients. Iran J Nurs Midwifery Res 2015; 20 (1) 63-68
- 75 Hepworth JT, Hendrickson SG, Lopez J. Time series analysis of physiological response during ICU visitation. West J Nurs Res 1994; 16 (6) 704-717
- 76 Fumagalli S, Boncinelli L, Lo Nostro A , et al. Reduced cardiocirculatory complications with unrestrictive visiting policy in an intensive care unit: results from a pilot, randomized trial. Circulation 2006; 113 (7) 946-952
- 77 Roland P, Russell J, Richards KC, Sullivan SC. Visitation in critical care: processes and outcomes of a performance improvement initiative. J Nurs Care Qual 2001; 15 (2) 18-26
- 78 Simpson T. Critical care patients' perceptions of visits. Heart Lung 1991; 20 (6) 681-688
- 79 Hardin SR, Bernhardt-Tindal K, Hart A, Stepp A, Henson A. Critical-care visitation: the patients' perspective. Dimens Crit Care Nurs 2011; 30 (1) 53-61
- 80 Gonzalez CE, Carroll DL, Elliott JS, Fitzgerald PA, Vallent HJ. Visiting preferences of patients in the intensive care unit and in a complex care medical unit. Am J Crit Care 2004; 13 (3) 194-198
- 81 Bay EJ, Kupferschmidt B, Opperwall BJ, Speer J. Effect of the family visit on the patient's mental status. Focus Crit Care 1988; 15 (1) 11-16
- 82 Olsen KD, Dysvik E, Hansen BS. The meaning of family members' presence during intensive care stay: a qualitative study. Intensive Crit Care Nurs 2009; 25 (4) 190-198
- 83 Malacarne P, Corini M, Petri D. Health care-associated infections and visiting policy in an intensive care unit. Am J Infect Control 2011; 39 (10) 898-900
- 84 Eriksson T, Bergbom I. Visits to intensive care unit patients—frequency, duration and impact on outcome. Nurs Crit Care 2007; 12 (1) 20-26
- 85 Lazure LL, Baun MM. Increasing patient control of family visiting in the coronary care unit. Am J Crit Care 1995; 4 (2) 157-164
- 86 Halm MA, Titler MG. Appropriateness of critical care visitation: perceptions of patients, families, nurses, and physicians. J Nurs Qual Assur 1990; 5 (1) 25-37
- 87 Ramsey P, Cathelyn J, Gugliotta B, Glenn LL. Visitor and nurse satisfaction with a visitation policy change in critical care units. Dimens Crit Care Nurs 1999; 18 (5) 42-48
- 88 Henneman EA, McKenzie JB, Dewa CS. An evaluation of interventions for meeting the information needs of families of critically ill patients. Am J Crit Care 1992; 1 (3) 85-93
- 89 Garrouste-Orgeas M, Philippart F, Timsit JF , et al. Perceptions of a 24-hour visiting policy in the intensive care unit. Crit Care Med 2008; 36 (1) 30-35
- 90 Baharoon S, Al Yafi W, Al Qurashi A , et al. Family satisfaction in critical care units: does an open visiting hours policy have an impact?. J Patient Saf 2014;
- 91 van den Broek JM, Brunsveld-Reinders AH, Zedlitz AMEE, Girbes AR, de Jonge E, Arbous MS. Questionnaires on family satisfaction in the adult ICU: a systematic review including psychometric properties. Crit Care Med 2015; 43 (8) 1731-1744
- 92 Cypress BS. Family presence on rounds: a systematic review of literature. Dimens Crit Care Nurs 2012; 31 (1) 53-64
- 93 Mangram AJ, Mccauley T, Villarreal D , et al. Families' perception of the value of timed daily “family rounds” in a trauma ICU. Am Surg 2005; 71 (10) 886-891
- 94 Jacobowski NL, Girard TD, Mulder JA, Ely EW. Communication in critical care: family rounds in the intensive care unit. Am J Crit Care 2010; 19 (5) 421-430
- 95 Doyle CJ, Post H, Burney RE, Maino J, Keefe M, Rhee KJ. Family participation during resuscitation: an option. Ann Emerg Med 1987; 16 (6) 673-675
- 96 Meyers TA, Eichhorn DJ, Guzzetta CE , et al. Family presence during invasive procedures and resuscitation. Am J Nurs 2000; 100 (2) 32-42 , quiz 43
- 97 Robinson SM, Mackenzie-Ross S, Campbell Hewson GL, Egleston CV, Prevost AT. Psychological effect of witnessed resuscitation on bereaved relatives. Lancet 1998; 352 (9128) 614-617
- 98 Benjamin M, Holger J, Carr M. Personal preferences regarding family member presence during resuscitation. Acad Emerg Med 2004; 11 (7) 750-753
- 99 Biancofiore G, Bindi LM, Barsotti E, Menichini S, Baldini S. Open intensive care units: a regional survey about the beliefs and attitudes of healthcare professionals. Minerva Anestesiol 2010; 76 (2) 93-99
- 100 da Silva Ramos FJ, Fumis RR, Azevedo LC, Schettino G. Perceptions of an open visitation policy by intensive care unit workers. Ann Intensive Care 2013; 3 (1) 34
- 101 Simpson T, Wilson D, Mucken N, Martin S, West E, Guinn N. Implementation and evaluation of a liberalized visiting policy. Am J Crit Care 1996; 5 (6) 420-426
- 102 Marco L, Bermejillo I, Garayalde N, Sarrate I, Margall MA, Asiain MC. Intensive care nurses' beliefs and attitudes towards the effect of open visiting on patients, family and nurses. Nurs Crit Care 2006; 11 (1) 33-41
- 103 Santiago C, Lazar L, Jiang D, Burns KE. A survey of the attitudes and perceptions of multidisciplinary team members towards family presence at bedside rounds in the intensive care unit. Intensive Crit Care Nurs 2014; 30 (1) 13-21
- 104 McClenathan BM, Torrington KG, Uyehara CFT. Family member presence during cardiopulmonary resuscitation: a survey of US and international critical care professionals. Chest 2002; 122 (6) 2204-2211
- 105 Boyd R, White S. Does witnessed cardiopulmonary resuscitation alter perceived stress in accident and emergency staff?. Eur J Emerg Med 2000; 7 (1) 51-53
- 106 [Anonymous] AACN Practice Alert: Family presence during CPR and invasive procedures. 2010 [cited 2015 August 11]. Available at: http://www.aacn.org/wd/practice/docs/practicealerts/family-presence-during-resuscitation-invasive-procedures.pdf
- 107 American Heart Association. 2005 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2005; 112 (24) (Supplement)
- 108 Donchin Y, Gopher D, Olin M , et al. A look into the nature and causes of human errors in the intensive care unit. Crit Care Med 1995; 23 (2) 294-300
- 109 Pilcher T, Odell M. Position statement on nurse-patient ratios in critical care. Nursing Standard 2000; 15 (12) 38-41
- 110 Groeger JS, Strosberg MA, Halpern NA , et al. Descriptive analysis of critical care units in the United States. Crit Care Med 1992; 20 (6) 846-863
- 111 Clark PF, Clark DA. Challenges facing nurses' associations and unions: a global perspective. Int Labour Rev 2003; 142 (1) 29-47
- 112 Anonymous. Projected Supply, Demand, and Shortages of Registered Nurses: 2000–2020. Washington, DC: U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, National Center for Health Workforce Analysis; 2002
- 113 Stechmiller JK. The nursing shortage in acute and critical care settings. AACN Clin Issues 2002; 13 (4) 577-584
- 114 Rocker GM, Cook DJ, Martin DK, Singer PA. Seasonal bed closures in an intensive care unit: a qualitative study. J Crit Care 2003; 18 (1) 25-30
- 115 Kelley MA, Angus D, Chalfin DB , et al. The critical care crisis in the United States: a report from the profession. Chest 2004; 125 (4) 1514-1517
- 116 Buerhaus PI, Staiger DO, Auerbach DI. Why are shortages of hospital RNs concentrated in specialty care units?. Nurs Econ 2000; 18 (3) 111-116
- 117 Cho SH, June KJ, Kim YM , et al. Nurse staffing, quality of nursing care and nurse job outcomes in intensive care units. J Clin Nurs 2009; 18 (12) 1729-1737
- 118 Poncet MC, Toullic P, Papazian L , et al. Burnout syndrome in critical care nursing staff. Am J Respir Crit Care Med 2007; 175 (7) 698-704
- 119 Mealer ML, Shelton A, Berg B, Rothbaum B, Moss M. Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses. Am J Respir Crit Care Med 2007; 175 (7) 693-697
- 120 Robnett MK. Critical care nursing: workforce issues and potential solutions. Crit Care Med 2006; 34 (3, Suppl): S25-S31
- 121 Depasse B, Pauwels D, Somers Y, Vincent JL. A profile of European ICU nursing. Intensive Care Med 1998; 24 (9) 939-945
- 122 Rose L, Nelson S, Johnston L, Presneill JJ. Workforce profile, organisation structure and role responsibility for ventilation and weaning practices in Australia and New Zealand intensive care units. J Clin Nurs 2008; 17 (8) 1035-1043
- 123 Metnitz PGH, Reiter A, Jordan B, Lang T. More interventions do not necessarily improve outcome in critically ill patients. Intensive Care Med 2004; 30 (8) 1586-1593
- 124 Metnitz B, Metnitz PG, Bauer P, Valentin A. ASDI Study Group. Patient volume affects outcome in critically ill patients. Wien Klin Wochenschr 2009; 121 (1–2) 34-40
- 125 Blot SI, Serra ML, Koulenti D , et al; EU-VAP/CAP Study Group. Patient to nurse ratio and risk of ventilator-associated pneumonia in critically ill patients. Am J Crit Care 2011; 20 (1) e1-e9
- 126 Valentin A, Capuzzo M, Guidet B , et al; Research Group on Quality Improvement of European Society of Intensive Care Medicine; Sentinel Events Evaluation Study Investigators. Patient safety in intensive care: results from the multinational Sentinel Events Evaluation (SEE) study. Intensive Care Med 2006; 32 (10) 1591-1598
- 127 Bastos PG, Knaus WA, Zimmerman JE, Magalhães Jr A, Sun X, Wagner DP ; Brazil APACHE III Study Group. The importance of technology for achieving superior outcomes from intensive care. Intensive Care Med 1996; 22 (7) 664-669
- 128 California Code of Regulations. Acute Respiratory Care Service Staffs. Title 22, Article 6, Item 70405. In: Regulations CCo ed
- 129 Sales A, Sharp N, Li Y-F , et al. The association between nursing factors and patient mortality in the Veterans Health Administration: the view from the nursing unit level. Med Care 2008; 46 (9) 938-945
- 130 Merkouris A, Papathanassoglou ED, Pistolas D, Papagiannaki V, Floros J, Lemonidou C. Staffing and organisation of nursing care in cardiac intensive care units in Greece. Eur J Cardiovasc Nurs 2003; 2 (2) 123-129
- 131 West E, Mays N, Rafferty AM, Rowan K, Sanderson C. Nursing resources and patient outcomes in intensive care: a systematic review of the literature. Int J Nurs Stud 2009; 46 (7) 993-1011
- 132 Penoyer DA. Nurse staffing and patient outcomes in critical care: a concise review. Crit Care Med 2010; 38 (7) 1521-1528 , quiz 1529
- 133 Numata Y, Schulzer M, van der Wal R , et al. Nurse staffing levels and hospital mortality in critical care settings: literature review and meta-analysis. J Adv Nurs 2006; 55 (4) 435-448
- 134 Kane RL, Shamliyan TA, Mueller C, Duval S, Wilt TJ. The association of registered nurse staffing levels and patient outcomes: systematic review and meta-analysis. Med Care 2007; 45 (12) 1195-1204
- 135 Garland A, Gershengorn H, Manthous CA. Intensive care unit staffing. In: Hall JH, Schmidt GA, Kress JP, , eds. Principles of Critical Care, 4th ed. New York: McGraw-Hill; 2015: 15-22
- 136 Pronovost PJ, Jenckes MW, Dorman T , et al. Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery. JAMA 1999; 281 (14) 1310-1317
- 137 Dang D, Johantgen ME, Pronovost PJ, Jenckes MW, Bass EB. Postoperative complications: does intensive care unit staff nursing make a difference?. Heart Lung 2002; 31 (3) 219-228
- 138 Pronovost PJ, Dang D, Dorman T , et al. Intensive care unit nurse staffing and the risk for complications after abdominal aortic surgery. Eff Clin Pract 2001; 4 (5) 199-206
- 139 West E, Barron DN, Harrison D, Rafferty AM, Rowan K, Sanderson C. Nurse staffing, medical staffing and mortality in intensive care: an observational study. Int J Nurs Stud 2014; 51 (5) 781-794
- 140 Carayon P, Gürses AP. A human factors engineering conceptual framework of nursing workload and patient safety in intensive care units. Intensive Crit Care Nurs 2005; 21 (5) 284-301
- 141 Canadian Association of Critical Care Nurses. Non-regulated health personnel in critical care areas. CACCN Position Statement. Toronto: Canadian Association of Critical Care Nurses; 1997
- 142 Ashby M, Bowman S, Bray K , et al; British Association of Critical Care Nurses. Position statement on the role of health care assistants who are involved in direct patient care activities within critical care areas. Nurs Crit Care 2003; 8 (1) 3-12
- 143 Needleman J, Buerhaus P, Pankratz VS, Leibson CL, Stevens SR, Harris M. Nurse staffing and inpatient hospital mortality. N Engl J Med 2011; 364 (11) 1037-1045
- 144 Checkley W, Martin GS, Brown SM , et al; United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study Investigators. Structure, process, and annual ICU mortality across 69 centers: United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study. Crit Care Med 2014; 42 (2) 344-356
- 145 Luke DA. Multilevel Modeling. London: SAGE Publications; 2004
- 146 Mark BA, Harless DW, McCue M, Xu Y. A longitudinal examination of hospital registered nurse staffing and quality of care. Health Serv Res 2004; 39 (2) 279-300
- 147 Garland A. Figuring out what works: a need for more and better studies on the relationship between ICU organization and outcomes. Crit Care 2010; 14 (1) 108