Workforce & Health Systems publications

Griffiths P, Saville C, Ball J, Dall'Ora C, Meredith P, Turner L, Jones J

Extensive research shows associations between increased nurse staffing levels, skill mix and patient outcomes. However, showing that improved staffing levels are linked to improved outcomes is not sufficient to provide a case for increasing them. This review of economic studies in acute hospitals aims to identify costs and consequences associated with different nurse staffing configurations in hospitals.

https://doi.org/10.1016/j.ijnurstu.2023.104601

September 2023

Almuhairi ES, Badejo M, Peer A, Pitkanen M, McKenzie CA

Delirium is a neuropsychiatric syndrome common in critical illness. Worsening delirium severity is associated with poorer clinical outcomes, yet its assessment remains under-reported with most severity assessment tools not validated for critical care. The DRS-R98 is a widely applied and validated tool. The aim of this project is to report the validation and utility of the DRS-R98 in critical illness.

https://doi.org/10.1177/08850666231199986

September 2023

Eadie R, McKenzie CA, Hadfield D, Kalk NJ, Bolesta S, Dempster M, McAuley DF, Blackwood B; UK ALERT-ICU study investigators

Background: Iatrogenic withdrawal syndrome, after exposure medication known to cause withdrawal is recognised, yet under described in adult intensive care.

Aim: To investigate, opioid, sedation, and preadmission medication practice in critically ill adults with focus on aspects associated with iatrogenic withdrawal syndrome.

https://doi.org/10.1007/s11096-023-01614-9

July 2023

Rubbo B,   Saville C, Dall'Ora C, Turner L, Jones J, Ball J, Culliford D, Griffiths P

Objectives: Examine the association between multiple clinical staff levels and case-mix adjusted patient mortality in English hospitals. Most studies investigating the association between hospital staffing levels and mortality have focused on single professional groups, in particular nursing. However, single staff group studies might overestimate effects or neglect important contributions to patient safety from other staff groups.

https://doi.org/10.1136/bmjopen-2022-066702

May 2023

Pearce S, McKenzie C

In this issue of Intensive & Critical Care Nursing, David Jarrett and colleagues have published a notable study (Jarret et al., 2023). This prospective observational study elegantly describes one of the lesser appreciated challenges in administering the correct dose into our patients in the intensive care unit (ICU)

https://doi.org/10.1016/j.iccn.2023.103445

May 2023

Dall'Ora   C, Ejebu OZ, Ball J, Griffiths P

Background: Nurses working long shifts (≥12 h) experience higher levels of burnout. Yet other shift characteristics, including fixed versus rotating night work, weekly hours and breaks have not been considered. Choice over shift length may moderate the relationship; however, this has not been tested.

Aims: To examine the association between shift work characteristics and burnout and exhaustion, and whether choice over shift length influences burnout and exhaustion.

https://doi.org/10.1093/occmed/kqad046

May 2023

Ankravs  MJ, McKenzie CA, Kenes MT

Delirium occurs in critical illness and is associated with poor clinical outcomes, having a longstanding impact on survivors. Understanding the complexity of delirium in critical illness and its deleterious outcome has expanded since early reports. Delirium is a culmination of predisposing and precipitating risk factors that result in a transition to delirium. Known risks range from advanced age, frailty, medication exposure or withdrawal, sedation depth, and sepsis. Because of its multifactorial nature, different clinical phenotypes, and potential neurobiological causes, a precise approach to reducing delirium in critical illness requires a broad understanding of its complexity. Refinement in the categorization of delirium subtypes or phenotypes (i.e., psychomotor classifications) requires attention. Recent advances in the association of clinical phenotypes with clinical outcomes expand our understanding and highlight potentially modifiable targets. Several delirium biomarkers in critical care have been examined, with disrupted functional connectivity being precise in detecting delirium. Recent advances reinforce delirium as an acute, and partially modifiable, brain dysfunction, and place emphasis on the importance of mechanistic pathways including cholinergic activity and glucose metabolism. Pharmacologic agents have been assessed in randomized controlled prevention and treatment trials, with a disappointing lack of efficacy. Antipsychotics remain widely used after "negative" trials, yet may have a role in specific subtypes. However, antipsychotics do not appear to improve clinical outcomes. Alpha-2 agonists perhaps hold greater potential for current use and future investigation. The role of thiamine appears promising, yet requires evidence. Looking forward, clinical pharmacists should prioritize the mitigation of predisposing and precipitating risk factors as able. Future research is needed within individual delirium psychomotor subtypes and clinical phenotypes to identify modifiable targets that hold the potential to improve not only delirium duration and severity, but long-term outcomes including cognitive impairment.

https://doi.org/10.1002/phar.2807

May 2023

Cameron   LK, Lumlertgul N, Bear DE, Cooney E, McKenzie C, Ostermann M

Micronutrients, principally vitamins and minerals, play an important role both in health and in disease. Parenteral micronutrient products are commonly prescribed for critically ill patients both in line with the terms of the product's license, and for other indications where there is an underpinning physiological rationale, or precedent, for their use but little evidence. This survey sought to understand United Kingdom (UK) prescribing practice in this area.

https://doi.org/10.1016/j.clnesp.2023.03.023

Dall’Ora, C., Rubbo, B., Saville, C. et al. The association between multi-disciplinary staffing levels and mortality in acute hospitals: a systematic review. Hum Resour Health 21, 30 (2023). https://doi.org/10.1186/s12960-023-00817-5

Published: 20 April 2023

DOI https://doi.org/10.1186/s12960-023-00817-5

Objectives

Health systems worldwide are faced with the challenge of adequately staffing their hospital services. Much of the current research and subsequent policy has been focusing on nurse staffing and minimum ratios to ensure quality and safety of patient care. Nonetheless, nurses are not the only profession who interact with patients, and, therefore, not the only professional group who has the potential to influence the outcomes of patients while in hospital. We aimed to synthesise the evidence on the relationship between multi-disciplinary staffing levels in hospital including nursing, medical and allied health professionals and the risk of death.

Dall’Ora, C., Rubbo, B., Saville, C. et al. The association between multi-disciplinary staffing levels and mortality in acute hospitals: a systematic review. Hum Resour Health21, 30 (2023). https://doi.org/10.1186/s12960-023-00817-5

Abstract

Objectives

Health systems worldwide are faced with the challenge of adequately staffing their hospital services. Much of the current research and subsequent policy has been focusing on nurse staffing and minimum ratios to ensure quality and safety of patient care. Nonetheless, nurses are not the only profession who interact with patients, and, therefore, not the only professional group who has the potential to influence the outcomes of patients while in hospital. We aimed to synthesise the evidence on the relationship between multi-disciplinary staffing levels in hospital including nursing, medical and allied health professionals and the risk of death.

Methods

Systematic review. We searched Embase, Medline, CINAHL, and the Cochrane Library for quantitative or mixed methods studies with a quantitative component exploring the association between multi-disciplinary hospital staffing levels and mortality.

Results

We included 12 studies. Hospitals with more physicians and registered nurses had lower mortality rates. Higher levels of nursing assistants were associated with higher patient mortality. Only two studies included other health professionals, providing scant evidence about their effect.

Conclusions

Pathways for allied health professionals such as physiotherapists, occupational therapists, dietitians, pharmacists, to impact safety and other patient outcomes are plausible and should be explored in future studies.

https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-023-00817-5

Christina Saville PhD, Peter Griffiths PhD, RN (Published 8 May 2021)

Aims

To assess how well the Safer Nursing Care Tool (SNCT) predicts staffing requirements on hospital wards, and to use professional judgement to generate hypotheses about factors associated with a “poor fit”.

External web link - https://onlinelibrary.wiley.com/doi/10.1111/jonm.13341

Chiara Dall'ora, Peter Griffiths, Joanna Hope, Jim Briggs, Jeremy Jones, Stephen Gerry & Oliver C Redfern (June 2021)

Introduction

Monitoring vital signs in hospital is an important part of safe patient care. However, there are no robust estimates of the workload it generates for nursing staff. This makes it difficult to plan adequate staffing to ensure current monitoring protocols can be delivered.

External web link - https://doi.org/10.1016/j.ijnurstu.2021.103921