What we talk about when we talk about NICUs: infants’ acuity and nurse staffing*

Abstract

Objective: Organizational features of neonatal intensive care influence the care of sick neonates. We estimated the acuity-adjusted nurse-to-patient ratio (NPR) in a national sample of Italian NICUs and factors influencing it.

Methods: Twelve monthly cross-sectional surveys were prospectively carried out in 63 NICUs. Number and acuity of infants, and number of nurses were recorded. Infants’ acuity was assessed by Rogowki’s 2013 and British Association for Perinatal Medicine 2001 classifications.

Results: We collected 702 reports regarding 11 082 infants. Non-intensive infants represented about 75% of NICU residents. Very preterm infants (<1501 g birth weight or <30 weeks gestation) represented 10.8% of admissions, but 44% of all infants surveyed.

Average acuity-adjusted NPR was 0.31 (interquartile range 0.28–0.38); NPR depended on case-mix (proportion of intensive infants), size of the unit (larger units had a lower NPR) and was higher during morning shifts (+18%). Clustering on hospitals, reflecting shared components within each hospital, explained 47% of the variability of NPR.

Conclusions: The majority of infants cared for in NICUs are not intensive. NPR is influenced by acuity of infants, size of units, shifts, but is largely due to other unobserved hospital-related organizational features.

• Intensive care
• nurse workload
• nurse-to-patient ratio
• organization of care

Acknowledgements

We thank Professor Piergiorgio Duca, University of Milan, for his useful suggestions on data analysis.

The SONAR study investigators were: Roberto Bellù (Lecco); Mara Vanzati (Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università di Milano); Mario Barbarini (Como S. Anna); Raffaella Contiero, (Ferrara); Serena Ellero (Udine (Torino S.Anna); Francesco Tandoi (Varese); Renato Lucchini (Università di Roma, Policlinico Umberto I); Claudio Gallo (Modena); Simona Boccacci (Mantova); Lorenzo Quartulli (Brindisi); Stefano Martinelli (Milano Niguarda); Debora Simonetti (Campobasso); Carlo Zorzi (Camposampiero); Palma Mammoliti (Rimini); Laura Barberis (Torino); Gianpaolo Gancia (Cuneo); Francesco Messina (Napoli Villa Betania); Paola Lago (Padova); Stefano Visentin (Treviso); Giuseppe Presta (Tricase); Carlo Poggiani (Cremona); Antonella Poloniato (Milano San Raffaele); Giampiero Burgio (Bergamo); Alessandro Arco (Messina); Carlo Dani (Firenze Careggi); Giacomo Faldella (Bologna S.Orsola); Andrea Parola (Novara); Alessandra Bertolini (Verona Borgo Roma); Luca Massenzi (Roma Fatebenefratelli Isola Tiberina); Gennaro Salvia (Napoli Buon Consiglio – F.B.F.); Vincenzo Forziati (Acquaviva delle Fonti); Fabrizio Sandri (Bologna Ospedale Maggiore); Carmine Deni Costabile (Cosenza); Olga Ganguzza (Palermo Buccheri La Ferla F.B.F.); Cristina Haass (Roma S. Pietro F.B.F.); Alberto Gatta (S.Giovanni Rotondo); Antonio Boldrini (Pisa); Patrizia Braghetti (Perugia); Luigi Orfeo (Benevento); Nicola Laforgia (Bari Policlinico); Andrea Dotta (Roma Bambino Gesù); Augusto Biasini (Cesena); Luca Vecchiato (Vicenza); Giovanni Chello (Napoli Monaldi); Roberta Cacciavellani (Versilia Viareggio); Giuseppe Carrera (Lodi); Paolo Biban (Verona Ospedale Civile Maggiore – Borgo Trento); Gennaro Vetrano (Benevento Ospedale Fatebenefratelli); Giuseppe Marchesano (Nocera Inferiore); Daniele Merazzi (Como Valduce); Miriam Sabatini (Alessandria); Antonio Del Vecchio (Bari Di Venere); Giancarlo Gargano (Reggio Emilia); Isabella Mondello (Reggio Calabria); Aniello Pugliese (Napoli Cardarelli); Mario Giuffré (Palermo Policlinico Giaccone); Maria Pia Cigliano (Napoli SS Annunziata); Fernando Del Cuore (Lecce); Francesco Crescenzi (Terni); Luigi Di Leo (Torino Maria Vittoria).

Declaration of interest

The authors report no declaration of interests.

The SONAR study was sponsored by a non-restricted grant by Chiesi Pharmaceuticals. Chiesi had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Supplementary material available online