The bed occupancy rate and the availability of care staff in neonatal intensive care units influence the chances of survival of very premature babies, according to a Quebec study of 1,870 infants born between the 23e and the 32e week of pregnancy.
“When the bed occupancy rate is at 50% of the unit’s capacity, the percentage of serious complications is 30%,” explains Dr.r Bruno Piedboeuf, clinical physician and full professor at the Faculty of Medicine of Laval University. This percentage increases to 40% when 80% of the beds are occupied, and to 50% when the unit is at 110% capacity. »
Research is often interested in the effectiveness of drugs and care procedures, but relatively little in the impact of the organization of work and the management of personnel in the medical environment. “Yet, insists the Dr Piedboeuf, the biggest expense of a health system is the staff and their use remains very little studied. »
The conclusions of the research conducted by a team of researchers affiliated with McGill, Laval and Montreal universities surprised the doctor and researcher from Quebec. “The magnitude is greater than we expected. We thought there was an effect, but not of that order. It is clear that this questions us and that it will feed the reflections at the Ministry of Health. »
Almost full units at the CHU de Québec
In his practice at the CHU de Québec, Dr.r Bruno Piedboeuf notes that the occupancy rate in neonatal intensive care units rarely drops below 80%, or even 85%. “We often work in a full unit and we end up wondering where we are going to put the babies who arrive, he explains. It’s exceptional when it drops below 80%. »
Busy periods require more resources, observes the Dr Piedboeuf, which can disrupt the continual care that very premature babies need. “Very premature babies are hospitalized for several weeks or even months, and the first few days are crucial to prevent the development of severe complications. It’s the attention to detail that counts. »
The use of overtime also has an impact on the health of young patients, also notes the doctor. In a study published in 2016 and carried out jointly with researchers Marc Beltempo and Régis Blais, he had already determined that “a higher overtime rate among nurses increased the risk of developing a nosocomial infection”, that is- that is, infections contracted in healthcare settings.
Lessons for other units
The Dr Bruno Piedboeuf believes that the conclusions of the study on neonatal intensive care units are likely to apply to emergencies and other care units where the occupancy rate is high.
“It demonstrates the importance of taking an interest, and a lot, adds the researcher, in the organization of work and schedules in the Quebec health network. »
Of the 1,870 children born prematurely studied by the research team, 823 experienced serious complications and 153 lost their lives. The main ailments affected the lungs, the eyes and the digestive or nervous systems.
The Dr Piedboeuf recalls, however, that advances in modern medicine have greatly improved the survival prognoses of very premature babies, to such an extent that 95% of those born after 28e week of pregnancy survive.
“There has been a lot of improvement technically,” he concludes. But there is still work to be done on the work organization side. »
“We must constantly watch over them [et] the staff’s reaction time is crucial, emphasizes the Université Laval professor. Ideally, there should be a ratio of one nurse per child to ensure optimal care. »