Critical care staffing ratio and outcome of COVID-19 patients requiring intensive care unit admission during the first pandemic wave: a retrospective analysis across Switzerland from the RISC-19-ICU observational cohort.

Jeitziner, Marie-Madlen; Moser, André; Wendel-Garcia, Pedro D; Exl, Matthias Thomas; Keiser, Stefanie; Schuepbach, Reto A; Pietsch, Urs; Cereghetti, Sara; Boroli, Filippo; Marrel, Julien; Sigg, Anne-Aylin; Ksouri, Hatem; Schott, Peter; Dullenkopf, Alexander; Fleisch, Isabelle; Heise, Antje; Laurent, Jean-Christophe; Jakob, Stephan M; Hilty, Matthias P and Que, Yok-Ai (2022). Critical care staffing ratio and outcome of COVID-19 patients requiring intensive care unit admission during the first pandemic wave: a retrospective analysis across Switzerland from the RISC-19-ICU observational cohort. Swiss medical weekly, 152, w30183. EMH Schweizerischer Ärzteverlag 10.4414/smw.2022.w30183

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STUDY AIM

The surge of admissions due to severe COVID-19 increased the patients-to-critical care staffing ratio within the ICUs. We investigated whether the daily level of staffing was associated with an increased risk of ICU mortality (primary endpoint), length of stay (LOS), mechanical ventilation and the evolution of disease (secondary endpoints).

METHODS

We employed a retrospective multicentre analysis of the international Risk Stratification in COVID-19 patients in the ICU (RISC-19-ICU) registry, limited to the period between March 1 and May 31, 2020, and to Switzerland. Hierarchical regression models were used to investigate crude and adjusted effects of the critical care staffing ratio on study endpoints. We adjusted for disease severity and weekly caseload.

RESULTS

Among the 38 participating Swiss ICUs, 17 recorded staffing information. The study population included 437 patients and 2,342 daily assessments of patient-to-critical care staffing ratio. Median of daily patient-to-nurse ratio started at 1.0 [IQR 0.5-1.5; calendar week 9] and peaked at 2.4 (IQR 0.4-2.0; calendar week 16), while the median of daily patient-to-physician ratio started at 4.0 (IQR 2.1-5.0; calendar week 9) and peaked at 6.8 (IQR 6.3-7.3; calendar week 19). Neither the patient-to-nurse (adjusted OR 1.28, 95% CI 0.85-1.93; doubling of ratio) nor the patient-to-physician ratio (adjusted OR 1.07, 95% CI 0.87-1.32; doubling of ratio) were associated with ICU mortality. We found no association of daily critical care staffing on the secondary endpoints in adjusted models.

CONCLUSION

We found no association of reduced availability of critical care staffing resources in Swiss ICUs with overall ICU length of stay nor mortality. Whether long-term outcome of critically ill patients with COVID-19 have been affected remains to be studied.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Jeitziner, Marie-Madlen; Moser, André; Jakob, Stephan and Que, Yok-Ai

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1424-7860

Publisher:

EMH Schweizerischer Ärzteverlag

Language:

English

Submitter:

Pubmed Import

Date Deposited:

27 Jun 2022 08:39

Last Modified:

30 Jun 2022 19:17

Publisher DOI:

10.4414/smw.2022.w30183

PubMed ID:

35752962

Additional Information:

Jeitziner and Moser (shared first authorship) and Hilty and Que (shared last authorship) contributed equally to this work.

BORIS DOI:

10.48350/170937

URI:

https://boris.unibe.ch/id/eprint/170937

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