Impact of Staffing Prioritization Plan During High Patient Census/Low Staffing Crises

Abstract

Background:

The shortage of respiratory therapists (RTs) has been felt nationwide since the COVID-19 pandemic. Our facility utilizes a workload-based projection driven by the Safe and Effective Staffing Guide to determine the number of RTs needed for units throughout the hospital. In 2022, a staffing prioritization policy was implemented to allow RTs to prioritize critical/urgent needs as they arose during times of high acuity or low staffing and perform non-critical work less frequently. A percentage of total RTs required compared to the number of RTs scheduled was used to classify a shift as critically staffed shifts (CSS) with instructions for prioritization. Staffing zones consisted of green zone (≥80% staffed); CCS classified as yellow (60-80%), and red (<60%) (Figure 1). By adapting to this system- RTs were able to plan accordingly within their assigned unit to provide the best care to patients in moments of need. This study aimed to review the impact of CCS on patient outcomes related to key safety events (KSE).

Methods:

An IRB-approved retrospective review evaluated KSE (unplanned extubations (UE), number and min of late medications, and incident reports (IR)) compared to the number of shifts identified as CSS (yellow or red) due to high census and/or low RT staffing from 10/1/2022-4/30/2023. Incident Reports were excluded from analysis if they were not associated with respiratory care services, patients, or therapists. There were no other exclusions.

Results:

151 shifts were identified as CSS of 422 total shifts (36%). November 2022 had the highest number of CSS (71%) and the most consecutive CSS (20 shifts over a period of 10 days). 5 unplanned extubations (UE) occurred during the study period with the most occurring in the month with the best staffing (April). There was no significant difference in percentage or time of late medications (average 2% and 91.4 min). There was an increase in incident reports in the month with the second highest RT staffing (January). Figure 2 displays the analysis per month.

Conclusions:

There was no direct correlation between RT staffing levels and patient outcomes during the study period. The largest changes in potential negative patient outcomes (IRs and UEs) were associated with the two months with the highest RT staffing percentages. Further research must be done to include emergent responses (code blue, rapid response) and more detailed shift-based analysis.

Figure 1 displays the yellow and red response guidelines from the staffing prioritization plan.

Figure 2 displays the key safety events compared with staffing per shift for each month during the study period.