@article {505016,
	title = {Patient Mortality Is Associated With Staff Resources and Workload in the ICU: A Multicenter Observational Study.},
	journal = {Crit Care Med},
	volume = {43},
	number = {8},
	year = {2015},
	month = {2015 Aug},
	pages = {1587-94},
	abstract = {OBJECTIVE: Matching healthcare staff resources to patient needs in the ICU is a key factor for quality of care. We aimed to assess the impact of the staffing-to-patient ratio and workload on ICU mortality.

DESIGN: We performed a multicenter longitudinal study using routinely collected hospital data.

SETTING: Information pertaining to every patient in eight ICUs from four university hospitals from January to December 2013 was analyzed.

PATIENTS: A total of 5,718 inpatient stays were included.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: We used a shift-by-shift varying measure of the patient-to-caregiver ratio in combination with workload to establish their relationships with ICU mortality over time, excluding patients with decision to forego life-sustaining therapy. Using a multilevel Poisson regression, we quantified ICU mortality-relative risk, adjusted for patient turnover, severity, and staffing levels. The risk of death was increased by 3.5 (95\% CI, 1.3-9.1) when the patient-to-nurse ratio was greater than 2.5, and it was increased by 2.0 (95\% CI, 1.3-3.2) when the patient-to-physician ratio exceeded 14. The highest ratios occurred more frequently during the weekend for nurse staffing and during the night for physicians (p < 0.001). High patient turnover (adjusted relative risk, 5.6 [2.0-15.0]) and the volume of life-sustaining procedures performed by staff (adjusted relative risk, 5.9 [4.3-7.9]) were also associated with increased mortality.

CONCLUSIONS: This study proposes evidence-based thresholds for patient-to-caregiver ratios, above which patient safety may be endangered in the ICU. Real-time monitoring of staffing levels and workload is feasible for adjusting caregivers{\textquoteright} resources to patients{\textquoteright} needs.},
	issn = {1530-0293},
	doi = {10.1097/CCM.0000000000001015},
	author = {Neuraz, Antoine and Gu{\'e}rin, Claude and Payet, C{\'e}cile and Polazzi, St{\'e}phanie and Aubrun, Fr{\'e}d{\'e}ric and Dailler, Fr{\'e}d{\'e}ric and Lehot, Jean-Jacques and Piriou, Vincent and Neidecker, Jean and Rimmel{\'e}, Thomas and Schott, Anne-Marie and Duclos, Antoine}
}
