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A multicenter observational study investigating care errors, staffing levels, and workload in small animal intensive care units
Author(s) -
Hayes Galina M.,
Bersenas Alexa M.,
Mathews Karol,
Lane William G.,
LaLondePaul Denise F.,
Steele Andrea,
Avellaneda Ana
Publication year - 2020
Publication title -
journal of veterinary emergency and critical care
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.886
H-Index - 47
eISSN - 1476-4431
pISSN - 1479-3261
DOI - 10.1111/vec.12991
Subject(s) - medicine , staffing , odds ratio , technician , observational study , confidence interval , emergency medicine , intensive care unit , workload , intensive care , acute care , intensive care medicine , health care , nursing , electrical engineering , computer science , engineering , economics , economic growth , operating system
Objective To investigate associations among care errors, staffing, and workload in small animal ICUs. Design Multicenter observational cohort study conducted between January 2017 and September 2018. Setting Three small animal teaching hospital ICUs. Animals None. Interventions None. Measurements and main results Data on patient numbers, illness severity (assesed via the acute patient physiologic and laboratory evaluation [APPLE] score), care burden, staffing levels, technician experience/education level, and care errors were collected at each study site. Care errors were categorized as major (unanticipated arrest or death; patient endangerment through IV line, arterial catheter, chest tube or other invasive device mismanagement, or errors in drug calculation/administration) or minor. Median patient:technician ratio was 4.3 (range: 1–18). Median patient illness severity was 15.1 (4.7–27.1) APPLE score units. A total of 221 major and 3,317 minor errors were observed over the study period. The odds of a major error increased by an average of 11% (odds ratio [OR] = 1.11; 95% confidence interval [CI], 1.02–1.20; P = 0.012) for each 1 patient increase in the patient:technician ratio after averaging by ICU location. The major error incident rate ratio was 2.53 (95% CI, 1.84–3.54; P < 0.001) for patient:technician ratios of >4.0 compared with ≤4.0. The odds of a major error increased by 0.5% per total unit APPLE score increase (OR = 1.005; 95% CI, 1.002–1.007; P < 0.001). The major error incident rate ratio was 1.71 (95% CI, 1.30–2.25; P < 0.001) for APPLE fast :technician ratios of >73 compared with ≤73. The odds of a major error decreased by 2% (OR = 0.98; 95% CI, 0.97–0.99; P = 0.01) for each year increase in total technician years of ICU work experience. Conclusions Substantial reductions in major care errors may be achieved by maintaining ICU patient:technician ratios at ≤4. Technician experience and total unit burden of patient illness severity are also associated with error incidence, and should be taken into consideration when scheduling staff.