Oral or Poster Presentation
Concurrent Session 2A - Neonatal Clinical Epidemiology
Introduction: Nurse-to-patient ratios (NPR) are associated with outcomes of preterm infants in the NICU. However, several NPR scores exist and it is unclear if they are equivalent. We aimed to compare three NPR scores and assess their association with mortality / morbidity among very preterm infants.
Methods: Retrospective cohort study of infants born <33 weeks and admitted to the Montreal Children’s Hospital 52 bed Level-3 NICU in 2017-2018. The number of recommended nurses was estimated for each shift using three NPR scores: the Winnipeg Assessment of Neonatal Nursing Needs Tool (WANNNT), the Quebec provincial NICU nursing ratio (QPNNR) and the Canadian NICU resource utilization (CNRU). Using the WANNNT as reference, we compared the recommended number of nurses for each shift using the three guidelines. The association between NICU nursing provision ratio (actual number of nurses / recommended number of nurses per shift) during the first 7 days of hospitalization with mortality / morbidity was assessed using logistic regression models.
Results: The median number of nurses recommended for each shift using the WANNNT was 25.0 (IQR, 23.1-26.7) (Table 1). Correlation between WANNNT and QPNNR was high (r = 0.92, p <0.0001), but the QPNNR underestimated the recommended number of nurses per shift by 4.8 (95% CI 4.7-4.9). Correlation between nursing needs calculated using WANNNT and CNRU was low (r = 0.45, p <0.0001). Nursing provision ratio during the first seven days of admission calculated using both WANNNT and QPNNR was associated with mortality/morbidity (adjusted odds ratio [aOR] (95% CI): 0.92 (0.86-0.99); 0.94 (0.89-0.98), respectively) (Table 2).
Conclusion: Lower nursing provision ratio during the first seven days of admission is associated with an increased risk of mortality / morbidity in very preterm infants. Maintaining adequate nursing provision in the NICU should be part of quality improvement strategies.