The Association of Bedside Nurse Staffing on Patient Outcomes and Throughput in a Pediatric Cardiac Intensive Care Unit

Objective: Healthcare throughput is the progression of patients from admission to discharge, limited by bed occupancy and hospital capacity. This study examines Heart Center throughput, cascading effects of limited beds, transfer delays, and nursing staffing on outcomes utilizing elective surgery cancellation during the initial SARS-CoV-2 pandemic wave. Design: Retrospective single-center study of staffing, adverse events, and transfers were collected. Study period was January 1, 2018 – December 31, 2020 with the SARS-CoV-2 period March-May 2020. Main Results: There were 2,589 patients, median age 5 months (6 days-4 years), 1,543 (60%) surgical, 1,046 (40%) medical. Mortality was 3.9% (n=101), median stay 5 days (3-11 days), median 1:1 nurse staffing 40% (33%-48%), median occupancy 54% (43%-65%) for Stepdown Unit and 81% (74%-85%) for Cardiac Intensive Care Unit. Every 10% increase in Stepdown Unit occupancy had a 0.5-day increase in Cardiac Intensive Care Unit stay (p=0.044), 2.1% increase 2-day readmission (p=0.023), and 2.6% mortality increase (p<0.001). Every 10% increase in Cardiac Intensive Care Unit occupancy had 3.4% increase in surgical delay (p=0.016), 6.5% increase in transfer delay (p=0.020), and a 15% increase in total reported adverse events (p<0.01). Elective surgery cancellation is associated with reduced high occupancy days (23% to 10%, p<0.001), increased 1:1 nursing (34% to 55%, p<0.001), decreased transfer delays (19% to 4%, p=0.008), and decreased mortality (3.7% to 1.5%, p=0.044). Conclusions: Elective surgery cancellation was associated with increased 1:1 nursing and decreased mortality. Increased Cardiac Stepdown Unit occupancy was associated with longer Cardiac Intensive Care Unit stay, increased transfer and surgical delays.