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Nurse Staffing, Work Environment Affect In-Hospital Cardiac Arrest Survival

PHILADELPHIA – While in-hospital cardiac arrest (IHCA) survival rates might be low across the board in hospitals, some hospitals do much better at saving those lives than others. What makes the difference?

A study published recently in the journal Medical Care sought to answer that question. The University of Pennsylvania School of Nursing-led research found that better nurse staffing and a favorable work environment both were big contributors to success.

"These results add to a large body of literature suggesting that outcomes are better when nurses have a more reasonable workload and work in good hospital work environments," study authors wrote. "Improving nurse working conditions holds promise for improving survival following IHCA."

Despite the opportunity for early intervention in the hospital setting, less than a fourth of patients with IHCA are discharged from the hospital alive, according to background information in the article.

For the study employing the American Heart Association's "Get With The Guidelines-Resuscitation" database, researchers analyzed 2005-07 data from more than 11,000 adults with IHCA at 75 hospitals in four states. National surveys of hospital characteristics and nurse staffing were used to analyze how those factors played into hospital survival rates after IHCA.

With just 15% of the patients with IHCA surviving to hospital discharge, most of the events occurred in an intensive care unit (ICU), and 80% were witnessed. In fact, 88% of patients were on cardiac monitoring equipment when the cardiac arrest occurred.

The review found that factors affecting the chance of survival included whether the patients were being monitored and if they had a "shockable" heart rhythm.

Even after taking those and other issues into account, the study found that hospitals with higher nurse staffing levels had higher IHCA survival rates. On general medical-surgical units, each additional patient per nurse was associated with a 5% relative reduction in the odds of survival, according to the report.

At the same time, the likelihood of survival was 16% lower at hospitals where surveys indicated poor work environments.

While nurse staffing levels in ICUs did not significantly affect the chances of survival after IHCA, possibly because of increasing standardization, that appeared to be a factor on general medical-survival units.

“Nearly half of IHCAs occur on medical-surgical units, which also have the most variable staffing levels and the most problematic work environments,” the authors wrote, suggesting that having too large of a patient load interferes with nurses' ability to effectively monitor patients closely, identify changes in patient condition, and intervene with lifesaving efforts quickly when seconds are a life-and-death matter.