•Pneumococcal infections are associated with high morbidity, hospitalisation and mortality.•Invasive pneumococcal infections remain a public health problem with significant cost.•The Health Insurance ...and patient’s cost perspectives were considered.•Estimation of the hospitalization cost per age- and risk- groups were considered.•Pneumococcal infections justify more attention for vaccination.
pneumococcal infections are associated with high morbidity, hospitalisation and mortality. The objective of this study was to investigate the health and economic burden of all-cause pneumonia and invasive pneumococcal disease in Belgian hospital settings, by patient’s age and risk profile.
This descriptive retrospective study was conducted in 17 Belgian hospitals. Univariate and multivariate logistic linear regression models were performed. The Health Insurance and patient’s cost perspectives were considered because a few studies report these costs.
The analysis has included 4,712 hospital admissions over the year 2018. Median hospitalization costs were higher for invasive pneumococcal infection diagnosis than for all-cause pneumonia (p < 0,001), respectively 4,051€ and 3,362€. Other factors associated with higher hospitalization cost were patient’s high-risk profile, admission to emergency unit, transfer from nursing home, admission to intensive care unit and length of stay.
Streptococcus pneumoniae infections remain a public health problem with significant cost for the Health Insurance and poor prognosis. Invasive pneumococcal infections are associated with longer hospital stays and required more intensive care than all other causes of pneumonia, in addition to be more costly, which justifies more attention for vaccination. This study also suggests an increase of economic and health burden with age and presence of underlying conditions.
The COVID-19 pandemic has had a significant impact on nursing practice in intensive care unit and consequently, on workload.
To assess the nurse-patient ratio required by COVID-19 patients and to ...identify the factors that influence nursing in this context.
This study was a retrospective observational study that evaluated the ratio using the Nursing Activities Score (NAS).
Three Belgian French-speaking hospitals, including five ICUs. Patients included COVID-19 and non-COVID-19 patients.
The study included 95 COVID-19 patients and 1604 non-COVID-19 patients (control group) resulting in 905 and 5453 NAS measures, respectively. The NAS was significantly higher among the COVID-19 patients than in the control group (p = <0.0001). In the COVID-19 group, these higher scores were also observed per shift and uniformly across the three hospitals. COVID-19 patients required more time in the activities of monitoring and titration (χ2 = 457.60, p = <0.0001), mobilisation (χ2 = 161.21, p = <0.0001), and hygiene (χ2 = 557.77, p = <0.0001). Factors influencing nursing time measured by NAS in the COVID-19 patients were age <65 years old (p = 0.23), the use of continuous venovenous hemofiltration (p = 0.002), a high APACHE II score (p = 0.006) and patient death (p = 0.002). A COVID-19 diagnosis was independently associated with an increase in nursing time (OR = 4.8, 95% CI:3.6–6.4).
Patients hospitalised in the ICU due to COVID-19 require significantly more nursing time and need an average ratio of almost 1:1.
Abstract
Background
Given the variability of intensive care unit (ICU) costs in different countries and the importance of this information for guiding clinicians to effective treatment and to the ...organisation of ICUs at the national level, it is of value to gather data on this topic for analysis at the national level in Belgium. The objectives of the study were to assess the total cost of ICUs and the factors that influence the cost of ICUs in hospitals in Belgium.
Methods
This was a retrospective cohort study using data collected from the ICUs of 17 Belgian hospitals from January 01 to December 31, 2018. A total of 18,235 adult ICU stays were included in the study. The data set was a compilation of inpatient information from analytical cost accounting of hospitals, medical discharge summaries, and length of stay data. The costs were evaluated as the expenses related to the management of hospital stays from the hospital’s point of view. The cost from the hospital perspective was calculated using a cost accounting analytical methodology in full costing. We used multivariate linear regression to evaluate factors associated with total ICU cost per stay. The ICU cost was log-transformed before regression and geometric mean ratios (GMRs) were estimated for each factor.
Results
The proportion of ICU beds to ward beds was a median p25-p75 of 4.7% 4.4–5.9. The proportion of indirect costs to total costs in the ICU was 12.1% 11.4–13.3. The cost of nurses represented 57.2% 55.4–62.2 of direct costs and this was 15.9% 12.0-18.2 of the cost of nurses in the whole hospital. The median cost per stay was €4,267 2,050–9,658 and was €2,160 1,545–3,221 per ICU day. The main factors associated with higher cost per stay in ICU were Charlson score, mechanical ventilation, ECMO, continuous hemofiltration, length of stay, readmission, ICU mortality, hospitalisation in an academic hospital, and diagnosis of coma/convulsions or intoxication.
Conclusions
This study demonstrated that, despite the small proportion of ICU beds in relation to all services, the ICU represented a significant cost to the hospital. In addition, this study confirms that nursing staff represent a significant proportion of the direct costs of the ICU. Finally, the total cost per stay was also important but highly variable depending on the medical factors identified in our results.
The optimal thromboprophylactic strategy for patients affected by Coronavirus disease 2019 (COVID-19) has been debated among experts. This study evaluated the safety and efficacy of a ...thromboprophylaxis algorithm. This was a retrospective, single-center study in critically ill patients admitted to the intensive care unit (University affiliated Hospital) for acute respiratory failure due to Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2). From March 16 to April 9, 2020, thromboprophylaxis was adjusted according to weight (control group, n = 19) and after this date, thromboprophylaxis depended on an algorithm based on thrombotic and hemorrhagic risk factors (protocol group, n = 13). With regard to safety (number of major bleeding events and blood transfusions), the groups were not significantly different. With regard to efficacy, the number of thrombotic events decreased from 37 to 0%,
p
= 0.025 after implementation of the algorithm. Also, peak fibrinogen dropped from 8.6 (7.2–9.3) to 6.5 (4.6–8.4) g/L,
p
= 0.041 and D-dimers from 2194 (1464–3763) to 1486 (900–2582) ng/mL,
p
= 0.0001. In addition, length of stay declined from 19 (10–31) to 5 (3–19) days,
p
= 0.009. In conclusion, a tailored thromboprophylaxis algorithm (risk stratification based on clinical parameters and biological markers) reduce thrombotic phenomena in critically ill COVID-19 patients without increasing major bleeding.
The aim of the study was to assess the prevalence of academic burnout (AB) and its associated factors among nursing and midwifery students during the COVID-19 pandemic.
A correlational ...cross-sectional study.
An online survey was distributed from November to December 2020 to nursing and midwifery students in Belgium. The risk of AB was assessed using the MBI-SS Academic Burnout Inventory scale. Factors associated with AB were related to the personal life and level of education of the student and to the COVID-19 pandemic.
The prevalence of overall AB risk was 50.0% (95% CI 48.5-53.1). Factors significantly associated with higher risk of AB were having a child, having a job, the level of academic training, working overtime, insufficient personal protective equipment against viral contamination during the last internship, work overload due to the pandemic, personal proven or possible SARS-CoV-2 infection and having a relative who died related to COVID-19.
Burnout is a global work-related phenomenon. Intensive care unit (ICU) nurses are at risk of burnout and the COVID-19 pandemic may increase this risk. The objectives of this study were to assess the ...prevalence of burnout risk and identify risk factors among ICU nurses during the COVID-19 pandemic.
Web-based survey performed during the first wave of the COVID-19 pandemic in French speaking Belgium.
Risk of burnout was assessed with the Maslach Burnout Inventory scale.
A total of 1135 ICU nurses responded to the questionnaire. The overall prevalence of burnout risk was 68%. A total of 29% of ICU nurses were at risk of depersonalisation (DP), 31% of reduced personal accomplishment (PA), and 38% of emotional exhaustion (EE). A 1:3 nurse-to-patient ratio increased the risk of EE (OR = 1.77, 95% CI: 1.07–2.95) and DP (OR = 1.38, 95% CI: 1.09–2.40). Those who reported having a higher perceived workload during the COVID-19 pandemic were at higher risk for all dimensions of burnout. Shortage of personal protective equipment increased the risk of EE (OR = 1.78, 95% CI: 1.35–3.34) and nurses who reported having symptoms of COVID-19 without being tested were at higher risk of EE (OR = 1.40, 95% CI: 1.68–1.87).
Two-thirds of ICU nurses were at risk of burnout and this risk was associated with their working conditions during the first wave of the COVID-19 pandemic. We recommend monitoring the risk of burnout and implementing interventions to prevent and manage it, taking into account the factors identified in this study.
Factors that influence this workload include continuous hemofiltration, high medical severity of illness scores and the high number of deceased patients. Besides that, the COVID-19-era is strongly ...associated with a high NAS (OR = 4.8, 95% CI: 3.6–6.4) compared to non-COVID-19 period (Bruyneel et al., 2021a). Wearing PPEs represent an important hindrance for communication with patients. ...the time dedicated to communication with the patient increased. ...we need to investigate how these new solutions, to provide the highest possible level of humanization in the care, could influence nursing workload.Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Aims
To estimate the prevalence of burnout risk among nurses during the peak of the first wave of the COVID‐19 pandemic in Belgium and to identify risk groups and protective and risk factors.
...Background
Nurses are at high risk of burnout, and this can have negative consequences for them, patients and health care systems. The pandemic may have changed their working conditions and increased their risk of burnout.
Methods
The risk of burnout was assessed through the Maslach Burnout Inventory Scale. Information on socio‐demographic and working conditions during the pandemic was also collected. We obtained 4552 respondents through convenience sampling.
Results
A high risk of burnout was found in 70% of respondents. The main risk factors of burnout were the lack of personal protective equipment, changes in perceived workload and working with COVID‐19 patients.
Conclusions
An uneven workload for nurses is an underlying problem during the COVID‐19 pandemic and a significant risk factor for their burnout. The decreased workload is a risk factor for burnout as important as increased workload and repeated exposure to COVID‐19.
Implications for Nursing Management
Burnout prevention and treatment interventions must target the correct risk factors and identify nurses at risk to be cost‐effective.
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