Improving staffing models in critical care units

17_314 Imperial NHS StM Ham-541

A study of staff perceptions of shift safety across 3 Intensive Care Units (ICUs) identified several factors that could improve existing staffing models.

ICUs are complex healthcare units, where adequate staffing is essential for best patient care. Nature and composition of the workforce, work environment and patient outcomes are inherently linked. ICU-specific staffing guidance is based predominantly on staff-to-patient ratios and severity of illness. Yet technological advances, increasing complexity of cases and expectations call for a review of traditional staff deployment models.

Ms Clare Leon-Villapalos, Lead Nurse for Education in Critical Care and IHC-BRC Fellow who led the study, explained: “We know that staff are our most valuable asset and it is important to explore what may impact on staff perceptions of safety.”

To address this, researchers from Imperial College Healthcare NHS Trust explored bedside professional-reported (BPR) perceptions of safety in intensive care staff across all professions and routinely collected organisational metrics. All ICU staff rated each shift as ‘safe, unsafe or very unsafe’ using a colour-coded stickers, collected over 29 consecutive days. Analysis of 2836 BPR scores revealed a correlation between perceptions of safety and severity of patient illness, number of patients and number of patients located in side rooms. Additionally, staff perceived a shift safer when percentage of staff with a specialist critical care course was higher (r=0.63).

The study has important practical implications for healthcare provision in ICUs. Participants found the BPR tool easy to implement, with high levels of engagement (58%), yielding data at individual ICU level that could inform local staff deployment decisions. Being able to communicate concerns may also play a role in reducing anxiety levels among ICU staff, where stress and burnout are areas of concern. Results of this study also provide merit for increased specialised staff training, ultimately improving staff well-being and patient care.

IHC-BRC Fellowship scheme is a joint training scheme between NIHR Imperial BRC and Imperial Health Charity, supporting career development of clinicians (medical and non-medical) through research.

  • Dr Stephen Brett
    Dr Stephen Brett
    Reader in Critical Care
  • Prof Mary Wells
    Prof Mary Wells
    Professor and Lead for Nursing and Midwifery - Theme Committee Member
  • Imperial Health Charity