Table 5. Effects of Workload Variables on Missed Care Outcomes.
| Outcome | Objective Workload Variables | All Workload Variables | |||||
|---|---|---|---|---|---|---|---|
| Staffing Ratio | Infant Acuity Score, OR (95% CrI)b,c | Staffing Ratio | Infant Acuity Score, OR (95% CrI)b,c | NASA-TLX Rating, OR (95% CrI)b,c | |||
| No. of Infants per Nursea | OR (95% CrI)b | No. of Infants per Nursea | OR (95% CrI)b | ||||
| Any missed care | 2:1 | 2.01 (1.57-2.55)d | 1.07 (1.06-1.09)d | 2:1 | 1.30 (1.04-1.66) | 1.05 (1.04-1.06)d | 1.20 (1.17-1.23)d |
| ≥3:1 | 4.53 (3.15-6.22)d | ≥3:1 | 1.66 (1.18-2.30)d | ||||
| Missed hourly IV site assessment | 2:1 | 3.36 (2.34-4.64)d | 1.02 (1.00-1.03) | 2:1 | 2.29 (1.55-3.17)d | 0.99 (0.98-1.02) | 1.20 (1.16-1.24)d |
| ≥3:1 | 8.41 (4.67-13.78)d | ≥3:1 | 3.28 (1.76-5.54)d | ||||
| Missed central venous catheter infection prevention bundle | 2:1 | 2.67 (1.76-3.88)d | 1.01 (0.99-1.03) | 2:1 | 1.82 (1.22-2.66)d | 0.99 (0.97-1.01) | 1.19 (1.14-1.24)d |
| ≥3:1 | 6.99 (3.54-12.35)d | ≥3:1 | 2.79 (1.39-4.93)d | ||||
| Missed oral feeding | 2:1 | 2.42 (0.75-7.69) | 1.06 (1.02-1.10)d | 2:1 | 1.06 (0.39-2.54) | 1.04 (1.01-1.08) | 1.20 (1.14-1.26)d |
| ≥3:1 | 5.66 (1.60-17.55)d | ≥3:1 | 1.51 (0.47-4.08) | ||||
| Missed patient assessment | 2:1 | 3.54 (2.27-5.52)d | 1.03 (1.02-1.05)d | 2:1 | 2.02 (1.23-3.18)d | 1.00 (0.98-1.02) | 1.34 (1.29-1.38)d |
| ≥3:1 | 10.04 (5.65-16.79)d | ≥3:1 | 2.70 (1.47-4.67)d | ||||
| Missed obtaining laboratory samples | 2:1 | 1.27 (0.75-2.14) | 1.00 (0.97-1.03) | 2:1 | 0.88 (0.45-1.56) | 0.98 (0.94-1.01) | 1.18 (1.12-1.26)d |
| ≥3:1 | 1.46 (0.47-3.40) | ≥3:1 | 0.69 (0.20-1.60) | ||||
| Missed parent involvement | 2:1 | 1.10 (0.68-1.80) | 1.05 (1.02-1.08)d | 2:1 | 0.77 (0.44-1.25) | 1.03 (1.01-1.06)d | 1.15 (1.10-1.20)d |
| ≥3:1 | 2.53 (1.23-4.71) | ≥3:1 | 1.20 (0.53-2.32) | ||||
| Missed ventilator-associated respiratory infection prevention bundle | 2:1 | 1.93 (1.03-3.36) | 1.05 (1.01-1.09) | 2:1 | 1.42 (0.71-2.55) | 1.03 (0.99-1.06) | 1.16 (1.09-1.24)d |
| ≥3:1 | 4.87 (1.45-11.92)d | ≥3:1 | 2.56 (0.71-6.38) | ||||
| Missed handoff | 2:1 | 1.15 (0.63-1.99) | 1.01 (0.98-1.04) | 2:1 | 0.89 (0.50-1.50) | 0.99 (0.97-1.02) | 1.22 (1.15-1.27)d |
| ≥3:1 | 3.96 (1.90-7.63)d | ≥3:1 | 1.70 (0.79-3.24) | ||||
| Missed 6 rights during medication administration | 2:1 | 2.38 (1.31-4.02)d | 1.05 (1.02-1.07)d | 2:1 | 1.50 (0.84-2.53) | 1.02 (1.00-1.05) | 1.23 (1.18-1.28)d |
| ≥3:1 | 2.88 (1.19-5.65) | ≥3:1 | 1.06 (0.41-2.22) | ||||
| Missed double-check of high-risk medication | 2:1 | 1.04 (0.54-1.78) | 1.03 (0.99-1.07) | 2:1 | 0.86 (0.40-1.63) | 1.01 (0.97-1.05) | 1.13 (1.05-1.23)d |
| ≥3:1 | 1.02 (0.09-3.59) | ≥3:1 | 0.68 (0.06-2.41) | ||||
| Missed standard safety checks of equipment and alarms | 2:1 | 1.94 (0.95-3.70) | 1.02 (0.98-1.05) | 2:1 | 1.18 (0.61-2.21) | 0.99 (0.96-1.02) | 1.19 (1.13-1.26)d |
| ≥3:1 | 5.10 (2.07-10.87)d | ≥3:1 | 1.80 (0.70-3.86) | ||||
Abbreviations: IV, intravenous; NASA-TLX, National Aeronautics and Space Administration Task Load Index; OR, odds ratio; 95% CrI, 95% credible interval.
a
Reference category was 1 infant per nurse (1:1 ratio).
b
Each model controlled for nurse education, certification, experience, unit census, and shift start time.
c
Rescaled to indicate change in odds per 5-unit increase in score.
d
P < .004, α corrected for false discovery rate.