News | Sudden Cardiac Arrest | December 16, 2015

Nurse Staffing, Work Environments Affect Survival After in-Hospital Cardiac Arrest

Study suggests reducing nurse workload, improving work conditions could improve IHCA survival rates

in-hospital cardiac arrest, IHCA, survival, nurse staffing, Medical Care

December 16, 2015 — Patients with in-hospital cardiac arrest (IHCA) have low survival rates—but why do some hospitals achieve higher survival than others? Higher nurse staffing levels and better working conditions may be part of the answer, reports a study in the January issue of Medical Care. The journal is published by Wolters Kluwer.

"These results add to a large body of literature suggesting that outcomes are better when nurses have a more reasonable workload and work in good hospital work environments," according to the new research study, led by the University of Pennsylvania School of Nursing's Matthew McHugh, Ph.D., JD, MPH, RN, associate director, Center for Health Outcomes and Policy Research. "Improving nurse working conditions holds promise for improving survival following IHCA."

Despite the chance of early intervention, less than one-fourth of patients with IHCA are discharged from the hospital alive. Some hospitals have been much more successful than others at improving survival after IHCA. Because nurses are the first link in the "Chain of Survival" in IHCA, factors related to nurse staffing might help to explain these variations.

McHugh and colleagues analyzed 2005-07 data on more than 11,000 adults with IHCA at 75 hospitals in four states, drawn from the American Heart Association's "Get With The Guidelines-Resuscitation" database. Data from national surveys of hospital characteristics and nurse staffing were used to analyze how these factors affected hospital survival rates after IHCA.

Only 15 percent of the patients with IHCA survived to hospital discharge. Most of the IHCAs occurred in an intensive care unit (ICU), and 80 percent were witnessed. Eighty-eight percent of patients were on cardiac monitoring equipment when their cardiac arrest occurred.

Several factors affected the chances of survival—including whether the patient had a "shockable" heart rhythm that can potentially be reversed by an electric shock. Patients who were being monitored were also more likely to survive.

But even after taking these and other factors into account, hospitals with higher nurse staffing levels had higher IHCA survival rates. On general medical-surgical units, each additional patient per nurse was associated with a 5 percent relative reduction in the odds of survival.

In addition, the likelihood of survival was 16 percent lower at hospitals with poor work environments. That classification was based on a survey evaluating key areas for professional nursing practice, such as nurse participation, leadership and support.

Nurse staffing levels in ICUs did not significantly affect the chances of survival after IHCA. That likely reflected limited variation in ICU staffing levels due to increasing standardization.

By comparison, staffing on general medical-survival units varies considerably between hospitals. McHugh and coauthors noted, "Nearly half of IHCAs occur on medical-surgical units, which also have the most variable staffing levels and the most problematic work environments." The authors suspect that having too many patients to manage interferes with nurses' ability to effectively monitor patients closely, identify changes in patient condition, and intervene with lifesaving efforts quickly when seconds count.

The results add to a growing body of evidence that improving hospital work environments may be a promising approach to reducing preventable deaths—particularly after IHCA. "Adequate hospital nurse staffing may be an important strategy in efforts aimed at achieving excellent patient outcomes," the researchers wrote. But improving staffing may be difficult for some hospitals because of costs—nurses already account for more than 40 percent of direct care costs for hospitalized patients.

McHugh and colleagues believe that simply adding more nurses without considering the work environment may be a poor investment. They wrote, "Improvement of work environments...requires a change of inter-professional culture and extended delegation of care management to those care providers who are closest to patients."

For more information: www.journals.lww.com/lww-medicalcare

Related Content

FDA Releases New Report Assessing Quality, Safety and Effectiveness of Medical Device Servicing
News | Cardiovascular Business | June 07, 2018
A new report from the U.S. Food and Drug Administration (FDA) discusses the continued quality, safety and effectiveness...
DAIC Editor Dave Fornell won the 2018 AZBEE national silver award for best blog for "The Future of Cardiology: 17 Technologies to Watch. DAIC magazine - diagnostic and interventional cardiology magazine.
News | Cardiovascular Business | May 14, 2018
May 14, 2018 — Diagnostic and Interventional Cardiology (DAIC) magazine was honored with a ...
FDA Announces New Medical Device Safety Action Plan
News | Cardiovascular Business | April 25, 2018
The U.S. Food and Drug Administration (FDA) released a new Medical Device Safety Action Plan outlining how the agency...
DAIC Wins Two 2018 Regional Azbee Awards for Editorial Excellence
Feature | Cardiovascular Business | April 20, 2018
Diagnostic and Interventional Cardiology was honored with a pair of Azbee Awards for editorial excellence at the 2018...
DAIC Editor Dave Fornell displays the 2018 Neal Award for Best Use of Social Media
News | Cardiovascular Business | April 05, 2018
April 5, 2018 — Diagnostic and Interventional Cardiology (DAIC) magazine received the 2018 Jesse H.
Veritas Capital Acquiring Three Software Units from GE Healthcare
News | Cardiovascular Business | April 02, 2018
GE Healthcare announced the sale of its Value-Based Care Division — including its software assets for Enterprise...
The annual Azbee Awards are hosted by the American Society of Business Publication Editors (ASBPE) to recognize editorial and design excellence in the business, trade and specialty press. Dave Fornell won blog award for DAIC
News | Cardiovascular Business | March 08, 2018
Scranton Gillette Communications’ Diagnostic and Interventional Cardiology (DAIC) was recently named a 2018
Fysicon announced its acquisition by Canon Medical Systems Corporation.
News | Cardiovascular Business | March 08, 2018
Fysicon announced its acquisition by Canon Medical Systems Corporation. Linda Elberse, CEO of Fysicon, stated: "Being...
ACC 2018 Cardiovascular Summit Teaches Cardiology Best Practices
News | Cardiovascular Business | February 28, 2018
The American College of Cardiology’s Cardiovascular Summit will begin on Thursday, Feb. 22, 2018, bringing together...
FDA Releases Final Rule on Data Acceptance from Medical Device Clinical Investigations
News | Cardiovascular Business | February 21, 2018
The U.S. Food and Drug Administration (FDA) issued the final rule on “Human Subject Protection; Acceptance of Data from...
Overlay Init