Marga Hoogendoorn

109 Participants and period def inition All patients with a date of admission between March 2020 and July 1 st , 2020, to the six ICUs participating in the nursing capacity module were included for the COVID-19 period. All patients with a date of admission between March 1 st , 2019, and July 1 st , 2019, on those ICUs were included for the non-COVID period. Variables We defined four ICU patient cohorts: (1) patients admitted with a confirmed COVID-19 infection [positive polymerase chain reaction (PCR) test and/or confirmed COVID-19 on CT-Thorax i.e. a COVID-19 Reporting and Data System score (CO-RADS) of ≥ 4 in combination with the lack of an alternative diagnosis 11 ] during the COVID-period, (2) patients admitted with a pneumonia [aspiration, bacterial, fungal, parasitic of viral pneumonia or pulmonary sepsis] during the non-COVID period; (3) all non-COVID patients admitted to the ICU during the COVID period; and (4) all non-pneumonia patients admitted to the ICU during the non-COVID period. We used the Nursing Activities Score to measure the nursing workload on the ICU 12 . The Nursing Activities Score represents a total of 23 nursing activities in direct and indirect ICU patient care (e.g., hygiene procedures, mobilization and positioning, care of artificial airways, administration tasks) with a score representing the average time consumption per activity (appendix 2). A total score of 100 points has been defined equal to the time spent by one fulltime-equivalent nurse per shift. Validation with time measurements has shown that Nursing Activities Score explains 59-81% of the actual nursing time 12,13 . The interrater reliability of the Nursing Activities Score showed variable results (Kappa 0.02 – 0.69). The results are low for the items with categories of an estimated time by nurses (e.g. present at bedside and observation for two hours or more) 14 . This subjective estimation can lead to differences in NAS-scores and subsequently to differences in the calculated need for nursing staff 15,16 . Despite this consideration the Nursing Activities Score is widely used in different countries all over the world as a tool for planning nursing staff in daily practice 17,18 . The use of NAS in Intensive Care is described in e.g. Belgium, Italy, the Netherlands, Norway, Spain, Portugal, Poland, Egypt, Greece and Brazil 19,20,21,22 . The nursing workload data in the capacity module of the NICE registry consists of all nursing activities within the Nursing Activities Score with updated data definitions and the sum-score per patient. The Nursing Activities Score is collected in the Electronic Health Record by the ICU nurse, at the end of each shift. Nurses of the hospitals using the capacity module are trained in the use of NAS and the data definitions.