DAILY WORK UTILIZATION RATIO AS MANAGING INSTRUMENT IN THE INTENSIVE CARE UNIT

Rosa AC, Leal P. UCI, Hospital Garcia de Orta, Almada, Portugal

INTRODUCTION: the Work Utilization Ratio (WUR) [1] was proposed in 1998 to evaluate the global efficiency in the use of nursing workload at the ICU. The objective of this work is to evaluate the potential utilization of the WUR, computed daily, in the evaluation of the adequacy of the nursing staff in the ICU.

MATERIAL AND METHODS: from 16/03 to 15/04/2000, nursing workload was evaluated daily, for all patients using the Nine Equivalents of Nursing Manpower use Score (NEMS) [2] in one mixed medical-surgical ICU with 8 beds. The efficiency of the use of nursing manpower was evaluated by the WUR, computed daily, dividing the utilized nursing workload by the available nursing workload in the ICU.

RESULTS: During the study period were evaluated a total of 233 patient/days. Mean daily NEMS for each patient was 28.9 ± 7.1 (15 - 45) points. Mean cumulative daily NEMS was 217.5 ± 32.5 (126 – 262) points. Overall, mean WUR was 0.946 ± 0.141 (0.548 - 1.139). It was apparent a very large variation among days, with 25.8 % of the working days presenting a WUR < than 0.9 and 9.7% of the days a WUR > 1.1.

CONCLUSIONS: Overall, in this ICU, the existent nursing staff seems adequate, with globally 94.6% of the available nursing workload being used, and only 25.8% of the working days with less than 90% of the nursing workload available being used. On the other side, just in 9.7% of the days the nursing staff of the ICU was confronted with a realized work greater than 110%. This new application of the WUR, allows an easy daily evaluation of the efficacy of the nursing workload use. It is consequently straightforward to evaluate the effects of changing the number of available nurses when there is a mismatch between the planned workload level and the observed workload level, computing immediately the potential consequences of that change.

REFERENCES:

1. Moreno R, Reis Miranda D. Nursing staff in intensive care in Europe. The mismatch between planning and practice. Chest 1998;113:752-8.

2. Reis Miranda D, Moreno R, Iapichino G. Nine equivalents of nursing manpower use score (NEMS). Intensive Care Med 1997;23:760-5.