SwissScoring - a nationwide survey of NEMS assessing practices and its accuracy

Perren, Andréas; Cerutti, Bernard; Merlani, Paolo; Perren, Ilaria; Previsdomini, Marco; Massarotto, Paola; Kaufmann, Mark; Rothen, Hans Ulrich

doi:10.1111/aas.12283

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…Previous studies yielded mixed results regarding the accuracy of organizational indicators such as NEMS or FTE's that were exported from the MDSi [38,64,65]. For instance, the ratio of registered nurses with ICU certification and registered nurses with no ICU certification may differ between units, resulting in a different skill mix and rendering some calculations using FTE's less reliable.…”

Section: Limitationsmentioning

confidence: 99%

“…Original article ventilation and agitated patients as surrogates of workload instead of adjusting these figures using FTE's, as we consider the overall accuracy of NEMS scoring, documentation of mechanical ventilation and patients' agitation to be within clinically acceptable range [64]. Moreover, figures such as NEMS are also used by Swiss insurance companies for reimbursement, and this should guide the clinician to strive for valid documentation.…”

Section: Limitationsmentioning

confidence: 99%

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Teamwork and clinician burnout in Swiss intensive care: the predictive role of workload, and demographic and unit characteristics

et al. 2019

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AIM: The levels of teamwork and clinician burnout in healthcare differ depending on demographic and unit characteristics. However, the impact of these characteristics varies between clinical settings. In addition, the impact of objectively measured workload in such settings is largely unknown. The aim of this study was to analyse the predictive role of demographic (e.g., professional experience) and unit (e.g., unit size) characteristics, and workload (e.g., nursing interventions) in explaining teamwork and clinician burnout in Swiss intensive care units (ICUs). METHODS: This was as cross-sectional multi-source study. Participants were 1148 nurses and 243 physicians working in 55 ICUs. They provided demographic information and answered a questionnaire on teamwork and clinician burnout. In addition, unit characteristics and surrogate measures of workload were extracted from a central database that accumulates patient and unit data routinely collected by the ICUs. We conducted multilevel regression analyses to detect relationships between study variables. RESULTS: Clinicians who worked predominantly dayshifts reported better teamwork and lower burnout. Physicians and clinicians in leadership positions also reported better teamwork. Clinicians in leadership positions furthermore reported higher personal accomplishment, whereas clinicians in training reported higher emotional exhaustion. Of the unit characteristics, workload was positively associated with self-reported burnout. Clinicians working in medical and surgical ICUs (compared with interdisciplinary and paediatric ICUs) reported higher emotional exhaustion. Clinicians working in university hospitals and in surgical/ medical ICUs reported lower teamwork quality and higher burnout.CONCLUSION: We identified several demographic and unit-based factors in Swiss ICUs that were associated with lower perceptions of the quality of teamwork and higher self-reported burnout. Discrepant experiences regarding the quality of teamwork based on professional role, pro-fessional status and experience might affect team effectiveness. Furthermore, this study showed the importance of workload management, as objectively measured workload was associated with higher self-reported burnout. Results suggested that certain clinician groups (e.g., working predominantly night shifts) were at higher risk for burnout, thus highlighting the importance of providing additional support to these groups. Lastly, special attention should be paid to medical and surgical ICUs, which reported the highest level of burnout. Because this is a cross-sectional study, no conclusions can be drawn regarding causal relationships.

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Section: Limitationsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Teamwork and clinician burnout in Swiss intensive care: the predictive role of workload, and demographic and unit characteristics

et al. 2019

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“…Today, a large number of institutions in the world uses NEMS for its simplicity and speed in scoring (13). For example, in Switzerland head nurses are motivated to ensure NEMS scoring is performed and validated (21). There are also numerous studies researching the relation of NEMS to other known scoring systems.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Nurses’ Workload in Intensive Care Unit by Use of Scoring Systems

Vuković

2020

Croat. nurs. j. (Online)

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Aim. To assess the level of correlation between two scoring systems: patient categorization according to the Croatian Nursing Council consensus and Nine Equivalents of Nursing Manpower Use Score (NEMS) and their ability to determine if the number of nurses working in the intensive care unit (ICU) is optimal to provide adequate nursing care, and to assess the level of correlation between the severity of patients’ illness and the level of nurses’ satisfaction with provided care. Methods. Research was performed in surgical ICU of the Clinical Department of Anesthesiology, Resuscitation and Intensive Care Medicine, University Hospital Dubrava, in the period between January 8th and April 14th, 2014. 256 patients aged 18-92 years were included in the study. Patient categorization and NEMS were calculated each day during the first 7 days of the ICU stay. NEMS was calculated using a pre-made table of variables and categorization was calculated using an electronic form included in nursing electronic patient files. Satisfaction of provided care was expressed using the Likert scale (1-5). Results. Study results have shown a moderate but significant level of correlation between the categorization and NEMS scores. Mean NEMS score during the first 7 days in the ICU was 26.93 ± 4.64 and the highest measured values were at day 4 (30.34±8.1) after which they started decreasing. Mean cumulative NEMS throughout the whole ICU stay was 269.3. According to the fact that according to NEMS scoring system one nurse can provide maximum of 45 points for 24 hours, the results have shown that a 10 bed ICU needs at least 5.98 (6) nurses to provide adequate level of care. Average categorization score was 57.83±4.29 and the highest recorded score was at day 7 (59.7±4.44). According to the categorization scoring system time needed to provide care for one 4th category patient throughout 24 hours is 10 or more hours. Since the description of the 4th category doesn’t specify what is the upper limit of time needed to provide care for each patient, 14 hours was used to determine a minimum number of nurses, and according to the categorization score 5.83 (6) nurses are needed in the ICU. Nurses’ satisfaction with provided care has shown a significant negative correlation with NEMS score and categorization score. Conclusion. Both scoring systems can be used to assess nursing workload in a surgical ICU. However, NEMS is simpler and quicker to use, more applicable, useful and should be routinely used in place of categorization to assess nursing workload in surgical ICUs.

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“…Submitting this information to the MDSi is mandatory; consequently, the data reflect the situation at the national level [21]. The data quality of the MD-Si has recently been assessed, and the results have been published [22]. The expansion of the pandemic did not allow timely mapping of COVID-19 in MDSi.…”

Section: Data Sourcementioning

confidence: 99%

Changes in diagnostic patterns and resource utilisation in Swiss adult ICUs during the first two COVID-19 waves: an exploratory study

Previsdomini,

Perren,

Chiesa

et al. 2024

Swiss Med Wkly

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BACKGROUND AND AIM: The coronavirus disease 2019 (COVID-19) outbreak deeply affected intensive care units (ICUs). We aimed to explore the main changes in the distribution and characteristics of Swiss ICU patients during the first two COVID-19 waves and to relate these figures with those of the preceding two years. METHODS: Using the national ICU registry, we conducted an exploratory study to assess the number of ICU admissions in Switzerland and their changes over time, characteristics of the admissions, the length of stay (LOS) and its trend over time, ICU mortality and changes in therapeutic nursing workload and hospital resources in 2020 and compare them with the average figures in 2018 and 2019. RESULTS: After analysing 242,935 patient records from all 84 certified Swiss ICUs, we found a significant decrease in admissions (–9.6%, corresponding to –8005 patients) in 2020 compared to 2018/2019, with an increase in the proportion of men admitted (61.3% vs 59.6%; p <0.001). This reduction occurred in all Swiss regions except Ticino. Planned admissions decreased from 25,020 to 22,021 in 2020 and mainly affected the neurological/neurosurgical (–14.9%), gastrointestinal (–13.9%) and cardiovascular (–9.3%) pathologies. Unplanned admissions due to respiratory diagnoses increased by 1971 (+25.2%), and those of patients with acute respiratory distress syndrome (ARDS) requiring isolation reached 9973 (+109.9%). The LOS increased by 20.8% from 2.55 ± 4.92 days (median 1.05) in 2018/2019 to 3.08 ± 5.87 days (median 1.11 days; p <0.001), resulting in an additional 19,753 inpatient days. The nine equivalents of nursing manpower use score (NEMS) of the first nursing shift (21.6 ± 9.0 vs 20.8 ± 9.4; p <0.001), the total NEMS per patient (251.0 ± 526.8 vs 198.9 ± 413.8; p <0.01) and mortality (5.7% vs 4.7%; p <0.001) increased in 2020. The number of ICU beds increased from 979 to 1012 (+3.4%), as did the number of beds equipped with mechanical ventilators (from 773 to 821; +6.2%). CONCLUSIONS: Based on a comprehensive national data set, our report describes the profound changes triggered by COVID-19 over one year in Swiss ICUs. We observed an overall decrease in admissions and a shift in admission types, with fewer planned hospitalisations, suggesting the loss of approximately 3000 elective interventions. We found a substantial increase in unplanned admissions due to respiratory diagnoses, a doubling of ARDS cases requiring isolation, an increase in ICU LOS associated with substantial nationwide growth in ICU days, an augmented need for life-sustaining therapies and specific therapeutic resources and worse outcomes.

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SwissScoring - a nationwide survey of NEMS assessing practices and its accuracy

Cited by 6 publications

References 13 publications

Teamwork and clinician burnout in Swiss intensive care: the predictive role of workload, and demographic and unit characteristics

Teamwork and clinician burnout in Swiss intensive care: the predictive role of workload, and demographic and unit characteristics

Assessment of Nurses’ Workload in Intensive Care Unit by Use of Scoring Systems

Changes in diagnostic patterns and resource utilisation in Swiss adult ICUs during the first two COVID-19 waves: an exploratory study

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