Alberto Lucchini1, Stefano Elli2, Christian De Felippis2, Carmen Greco3, Andrea Mulas3, Paolo Ricucci4, Roberto Fumagalli5, Giuseppe Foti2. 1. General Intensive Care Unit, Emergency Department - ASST Monza - San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza (MB), Italy. Electronic address: alberto.lucchini@unimib.it. 2. General Intensive Care Unit, Emergency Department - ASST Monza - San Gerardo Hospital, University of Milano-Bicocca, Via Pergolesi 33, Monza (MB), Italy. 3. General Intensive Care Unit, Fondazione IRCCS Istituto dei Tumori - Milano, Italy. 4. General Intensive Care Unit, Humanitas University Hospital, Milano, Italy. 5. Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, University Hospital of Milano-Bicocca, Milano, Italy.
Abstract
INTRODUCTION: The Nursing Activities Score (NAS) measures the amount of nursing time required for each patient and it has been widely used across Europe since its first validation in 2003. OBJECTIVE: To determine the nursing workload within an Extracorporeal Membrane Oxygenation (ECMO) Centre using a dedicated scoring tool. METHODS: Retrospective observational study. Data from NAS were collected for seventy-two consecutive months from January 2010. RESULTS: A total amount of 2606 patients were enrolled. Their median NAS recorded at Intensive Care Unit's admission was 69.8 (IQR: 56.2-82.9), whilst the daily average NAS was 68.1 (IQR: 58.3-76.7). ECMO patients enrolled were 95 (4%), with 3141 ECMO days. The median NAS of the ECMO patients versus patients without ECMO support was 87.0 (IQR: 82-96) and 67.2 (IQR: 58-78) respectively (p < 0.0001). The number of daily ECMO treatments showed a slight correlation with the average daily NAS (r = 0.176-p < 0.0001). CONCLUSIONS: Our findings suggest that in ECMO patients a nurse-to-patient ratio equal to 1:1, should be guaranteed in accordance to the national health regulations and organizations. The results of this study reinforce the current recommendation about the implementation of referral ECMO centres, in order to centralise patients, provide a dedicated clinical-technical support and also guarantee an adequate number of ECMO nurses supported by an accurate nurse management.
INTRODUCTION: The Nursing Activities Score (NAS) measures the amount of nursing time required for each patient and it has been widely used across Europe since its first validation in 2003. OBJECTIVE: To determine the nursing workload within an Extracorporeal Membrane Oxygenation (ECMO) Centre using a dedicated scoring tool. METHODS: Retrospective observational study. Data from NAS were collected for seventy-two consecutive months from January 2010. RESULTS: A total amount of 2606 patients were enrolled. Their median NAS recorded at Intensive Care Unit's admission was 69.8 (IQR: 56.2-82.9), whilst the daily average NAS was 68.1 (IQR: 58.3-76.7). ECMO patients enrolled were 95 (4%), with 3141 ECMO days. The median NAS of the ECMO patients versus patients without ECMO support was 87.0 (IQR: 82-96) and 67.2 (IQR: 58-78) respectively (p < 0.0001). The number of daily ECMO treatments showed a slight correlation with the average daily NAS (r = 0.176-p < 0.0001). CONCLUSIONS: Our findings suggest that in ECMO patients a nurse-to-patient ratio equal to 1:1, should be guaranteed in accordance to the national health regulations and organizations. The results of this study reinforce the current recommendation about the implementation of referral ECMO centres, in order to centralise patients, provide a dedicated clinical-technical support and also guarantee an adequate number of ECMO nurses supported by an accurate nurse management.