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

Health care 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 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic wave. This study was a retrospective single-center study of staffing, adverse events, and transfers. The study period was January 1, 2018 to December 31, 2020 with the SARS-CoV-2 period March to May 2020. There were 2,589 patients, median age 5 months (6 days-4 years), 1,543 (60%) surgical and 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 step-down unit, and 81% (74-85%) for cardiac intensive care unit. Every 10% increase in step-down unit occupancy had a 0.5-day increase in cardiac intensive care unit stay ( p = 0.044), 2.1% increase in 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 (23-10%, p < 0.001), increased 1:1 nursing (34-55%, p < 0.001), decreased transfer delays (19-4%, p = 0.008), and decreased mortality (3.7-1.5%, p = 0.044). In conclusion, Elective surgery cancellation was associated with increased 1:1 nursing and decreased mortality. Increased cardiac step-down unit occupancy was associated with longer cardiac intensive care unit stay, increased transfer, and surgical delays.