Nursing workload and prognosis in the critically ill obstetric patient

Introduction

A critically ill obstetric patient usually recovers rapidly after delivery, resulting in a short length of stay (LOS), with a reduced number of specific interventions in the ICU and a good overall prognosis. Some authors therefore stated a possible management of these patients on the delivery/labor floor or in high dependency units.

Objective

To measure nursing workload with the NEMS score [1], evaluate whether management in the ICU was required (NEMS > 20) and correlation with mortality.

Design

A retrospective chart review study.

Setting

An independent multidisciplinary ICU in a tertiary university hospital.

Study period

January 1996–June 2004.

Patients

All obstetric patients (n = 590) admitted to the ICU.

Measurements and results

Forty-nine patients were excluded due to insufficient data. Mean NEMS was 27.1 ± 6.75 with values ranging from 18 to 50. Mean NEMS for survivors was 25.8 ± 5.19, mean NEMS for nonsurvivors was 37.75 ± 8.78 (P < 0.001). A total 21.6% (n = 117) of our patients got a NEMS score < 20 (mean 18), among them 18 patients (15.4%) either increased their NEMS the next day and then died, or lasted with the same NEMS for a few days.

NEMS_H24 discriminated well with an AUROC of 0.855 ± 0.072, but calibrated badly (Pr < 0.001). Also NEMS_H48 (after excluding patients with LOS < 2 days) discriminated well (AUROC = 0.977), and calibrated better than NEMS_H24 but still insufficiently (Pr = 0.02).

Conclusion

According to the NEMS score 81.7% of our patients deserved to be hospitalized in the ICU. NEMS_H24 and NEMS_H48 correlated with mortality. Fifteen percent of patients with initial NEMS < 20 needed intensive monitoring for more than 1 day, and five patients died. We suggest a large admission policy to a multidisciplinary ICU be encouraged for obstetric patients, because monitoring is better and treatment of possible late complications occurs earlier, a sole guarantee to reduce mortality.