Background
Over 170,000 people spend time in critical care units in England and Wales each year, the majority surviving to be discharged home. Critically ill patients are classified according to patient dependence, ranging from Level 0 (needs met through usual ward care) to Level 3 (Patients needing advanced respiratory support and therapeutic support of multiple organs). This classification is used to match dependency to resources with nurse:patient ratios used to calculate nurse staffing required. This calculation is based on the assumption that sicker (Level 3/intensive care) patients require more nursing resource than those recovering from critical illness (Level 2/high dependency patients).
There have not been any evaluations of interventions to address nurse: patient ratios nor any attempts to quantify both the benefits and costs of nurse staffing. Whilst studies show associations between nurse staffing and outcomes, there are no studies showing i) how planned changes in staffing affect outcome, ii) whether a mismatch between staffing, as defined by a staffing tool, and that deployed is associated with adverse outcome, iii) whether staffing according to a tool improves outcomes, or iv) comparing one tool vs another in terms of ability to identify required staffing.
In this programme of work we aim to test a new model for the allocation of critical care nurse staffing and evaluate how this impacts on a range of patient, family, staff and organisation outcomes.
Methods
The programme development work will involve: a systematic review to identify outcomes most sensitive to nurse staffing in ICU; focus groups to elicit i) experiences of care and ideas about outcomes and ii) experiences and expectations of staffing models, with patients, family, clinicians and commissioners; feasibility of accessing data for outcomes, workforce and patient acuity. A stakeholder event will present findings, agree final staffing models and outcome measures.