The evaluation of nursing workload within an Italian ECMO Centre: A retrospective observational study

The Nursing Activities Score (NAS) measures the amount of nursing time required for each patient and it has been widely used across Europe since its first validation in 2003. To determine the nursing workload within an Extracorporeal Membrane Oxygenation (ECMO) Centre using a dedicated scoring tool. Retrospective observational study. Data from NAS were collected for seventy-two consecutive months from January 2010. A total amount of 2606 patients were enrolled. Their median NAS recorded at Intensive Care Unit’s admission was 69.8 (IQR: 56.2–82.9), whilst the daily average NAS was 68.1 (IQR: 58.3–76.7). ECMO patients enrolled were 95 (4%), with 3141 ECMO days. The median NAS of the ECMO patients versus patients without ECMO support was 87.0 (IQR: 82–96) and 67.2 (IQR: 58–78) respectively (p < 0.0001). The number of daily ECMO treatments showed a slight correlation with the average daily NAS (r = 0.176–p < 0.0001). Our findings suggest that in ECMO patients a nurse-to-patient ratio equal to 1:1, should be guaranteed in accordance to the national health regulations and organizations. The results of this study reinforce the current recommendation about the implementation of referral ECMO centres, in order to centralise patients, provide a dedicated clinical-technical support and also guarantee an adequate number of ECMO nurses supported by an accurate nurse management.