High Mortality and Multiple Organ Failure Incidences in Critical Care Units

Alice Johnson,

Address Details.


To the CEO,

Toronto General Hospital,

200 Elizabeth Street,

Toronto, ON

M5G 2C4.

Dear Dr Kelvin Smith

RE:  High Mortality and Multiple Organ Failure Incidences in Critical Care Units

Greetings, Dr Kelvin Smith; I am Alice Johnson, a registered nurse under the Canadian Nurses Association and Registered Nurses Association of Ontario, currently stationed in the critical care unit of Toronto General Hospital. I am writing to inform you of the current health crisis of multiple organ failure and mortality associated with nurse understaffing and excessive nurse workload.   Based on the recent critical care service audit findings, Toronto General Hospital has an estimated mortality rate of 24-36% associated with patient adverse outcomes of multiple organ failure (Jansson et al., 2020). The preliminary findings of the audit report and evidence-based research suggested that nurse shortage and increased nurse workload could be the main risk factors.

Furthermore, evidence-based medicine revealed that patients admitted to the Intensive Care Unit (ICU) and Post-anesthesia Care Unit (PACU) experienced episodes of severe hypoxemia, arterial hypotension and bradycardia after exposure to understaffed nurses working for long hours within 48 hours’ time flame. Further investigations by Galloway et al. (2018) and Kiekkas et al. (2019) measured the association between nursing understaffing, excessive nurse workload and multiple organ failure using the nurse-to-patient ratio (N/P), Therapeutic interventions Scoring System (TISS) score and Sequential Organ Failure Assessment (SOFA) score respectively. In their findings, patients’ mortality and adverse outcomes significantly increased with higher understaffed nurses who got overworked.

Moreover, an empirical study by Ball et al. (2018) pointed out that missed nursing care related to high nurse workload and understaffing leads to incidences of high patient mortality and severe hypoxemia, arterial hypotension and bradycardia because nurses were unable to timely survey and detected critical decrease of arterial oxygen saturation and arterial blood pressure and hence efforts to intervene and restore normal values failed. Similarly, nursing understaffing and excessive nurse workload in Toronto General Hospital could be caused by nurse burnout, rapid nurse turnover, job dissatisfaction, excess work overtime and fatigue (Jansson et al., 2020; Kiekkas et al., 2019).

On the other hand, the critical care department has tried to solve the issue of nurse shortage by making part-time nurses work overtime while restricting full-time nurses from excessive overtime to avoid fatigue. However, this strategy is ineffective in absenteeism, where part-time nurses get fatigued due to excessive overtime, thus risking patients’ lives in critical care units.

According to Hassmiller and Cozine’s (2006) research findings, critical care units need to implement more effective measures to reduce the aftermath of multiple organ failures. Toronto General Hospital could try to implement strategies similar to the Robert Wood Johnson Foundation (RWJF) to address nurse shortages and improve the quality of patient care in critical care units. RWJF’s strategies relevant to this context include transforming the work process and hospital culture. For these strategies to work, Toronto General Hospital must abolish the cost-effective policy that hinders the health facility from employing many registered nurses. In addition, implementing RWJF’s strategies will save nurses from wasting valuable time on redundant paperwork, searching for doctors and equipment and allow them to have sufficient time to monitor and care for critical care patients.

I believe that implementing RWJF’s strategies will help to reduce nurse shortage and excessive nurse workload associated with patients’ mortality and adverse outcomes. I expect that after six months, with the right strategies in place, the health crisis will reduce to 5-10% in mortality and multiple organ failure. Kindly, Dr Smith considers my proposal to save our patients and retain our health facility’s reputation. Please reach out for further comments and clarification.

Yours sincerely,

RN Name

Table of Contents


Ball, J.E., Bruyneel, L., Aiken, L.H., Sermeus, W., Sloane, D.M., Rafferty, A.M., … Griffiths, P. (2018). Post-operative mortality missed care and nurse staffing in nine countries: A cross-sectional study. International Journal of Nursing Studies, 78(1), 10-15.

Galloway, M., Hegarty, A., McGill, S., Arulkumaran, N., Brett, S. J., & Harrison, D. (2018).The effect of ICU out-of-hours admission on mortality: A systematic review and meta-analysis. Critical Care Medicine, 46, 290–299. https://doi.org/10.1097/CCM.00000 00000 002837

Hassmiller, S. B., & Cozine, M. (2006). Addressing the nurse shortage to improve the quality of patient care. Health Affairs25(1), 268-274.

Jansson, M., Ohtonen, P., Syrjälä, H., & Ala‐Kokko, T. (2020). The proportion of understaffing and increased nursing workload is associated with multiple organ failure: A cross‐sectional study. Journal of advanced nursing76(8), 2113-2124.

Kiekkas, P., Tsekoura, V., Aretha, D., Samios, A., Konstantinou, E., Igoumenidis, M., … & Fligou, F. (2019). Nurse understaffing is associated with adverse events in postanaesthesia care unit patients. Journal of clinical nursing28(11-12), 2245-2252.

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