• Sigrun Høegholm Kann, Sisse Anette Thomassen, Vijoleta Abromaitiene, and Carl-Johan Jakobsen.
• Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark. Electronic address: sigrun.kann@rsyd.dk.
• J. Cardiothorac. Vasc. Anesth. 2022 Jul 1; 36 (7): 1967-1974.

ObjectiveThe aim of this study was to describe changes in performance indicators such as length of stay [LOS] in the intensive care unit [ICU] and ventilation time, during the last six years in an attempt to identify associations between patient and systemic performance indicators, including the impact of nurse turnover.DesignA retrospective study of prospectively registered data (2013-2018). Propensity- score matching was performed to establish comparable groups.SettingThree Danish university hospitals.ParticipantsThe study included a total of 12,404 adult cardiac surgical patients registered in the Western Denmark Heart Registry. The cohort was divided into an "early" group (2013-2016) and a "late" group (2017-2018).InterventionsAn analysis of dynamics in patient indicators and systemic performance indicators, including the impact from selected performance parameters and nurse turnover.Measurements And Main ResultsComorbidity, calculated from the European System for Cardiac Operative Risk Evaluation, and the mean age were stable in the study period. Strong predictors of long LOS in the ICU included postoperative use of inotropes, re-exploration surgery, high postoperative drainage, and the "late" time group. Time parameters (relative risks) were all significantly longer in the "late" time group": ventilation time 1.21 (1.05-1.39), length of stay ICU 1.28 (1.11-1.48), and in-hospital time 1.36 (1.19-1.57). ICU nurse turnover increased from four (2013-2014) to 52 (2017-2018).ConclusionNo single patient factor, such as age or comorbidity, could explain the decrease in patient turnover in the ICU. In the same period, the turnover of ICU nurses increased. Patient turnover is complex and affected by a mix of patient and systemic performance factors.Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.

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