Fellow Stanford University Menlo Park, California, United States
Abstract:
Background: Over the past decade, contemporary intensive care units across North America have undergone significant growth and expansion. Thoughtful analysis of determinants of outcomes have appropriately focused on patient- and surgery-specific factors. Though some unit-level factors have been identified as important determinants of patient outcomes in pCICUs including nursing experience and workload, other unit-level structural features remain relatively unexplored. One such factor is the impact of the current night-time medical staffing model for the pediatric cardiac intensive care unit (pCICU). Similar to previous findings of worse outcomes associated with night shifts in adult and pediatric hospitals, we believe pCICUs may be at particular risk for several reasons, including known lag in hemodynamic lability following bypass for cardiac surgery and nurse/provider staffing differences between day and night shifts.
Methods: A retrospective single-center chart review was performed. PCICU admissions were reviewed for a single institution’s dedicated pCICU between 1/1/2018 to 7/13/2020. Data was abstracted and quantified for the time period above and arrest and mortality data were analyzed per shift. Available provider and nursing data was analyzed per shift.
Results: During this time period, there were 1963 admissions, 1023 (52%) occurring during the night shift (defined as 4 PM to 7 AM). When looking at cardiac arrest events, 84 events occurred during the entire study period with 44 (52%) occurring during the night shift. Mortality during the day shift was 55% and 61% during the night shift. For surgical ECMO events, there was 145 events during the entire study period, with 76 (52%) occurring during the night shift. Mortality of these events was 30% during the day shift and 44% during night shift. During the day shift, there were an average of 4 frontline providers and 2 attendings and 2 providers and 1 attending at night. Nursing expertise during the night shift was higher although with a higher standard deviation of experience compared to the those on day shift.
Conclusion: Based on single center data, we have reason to suspect that outcomes may potentially be worse during the night shift for arrest events and ECMO events. Such life threatening events (LTEs) are resource intensive events that apply stress to all staff in the pCICU and staffing models are important to consider in analyzing factors that contribute to outcomes. We are in the process of utilizing the Pediatric Cardiac Critical Care Consortium (PC4) database for a more complete understanding of the differences in LTEs that occur between the day and night shift.
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