Department of Critical Care, Imperial College Healthcare NHS Trust, London, UK
Imperial College London, London, UK.
BMJ Open. 2020 Jun 17;10(6):e034101. doi: 10.1136/bmjopen-2019-034101.
To explore bedside professional reported (BPR) perceptions of safety in intensive care staff and the relationships between BPR safety, staffing, patient and work environment characteristics.
An exploratory study of self-recorded staff perceptions of shift safety and routinely collected data.
A large teaching hospital comprising 70 critical care beds.
All clinical staff working in adult critical care.
Staff recorded whether their shift felt 'safe, unsafe or very unsafe' for 29 consecutive days. We explored these perceptions and relationships between them and routine data on staffing, patient and environmental characteristics.
Relationships between BPR safety and staffing, patient and work environment characteristics.
2836 BPR scores were recorded over 29 consecutive days (response rate 57.7%). Perceptions of safety varied between staff, including within the same shift. There was no correlation between perceptions of safety and two measures of staffing: care hours per patient day (r=0.13 p=0.108) and Safecare Allocate (r=-0.19 p=0.013). We found a significant, positive relationship between perceptions of safety and the percentage of level 3 (most severely ill) patients (r=0.32, p=0.0001). There was a significant inverse relationship between perceptions of safety and the percentage of level 1 patients on a shift (r=-0.42, p<0.0001). Perceptions of safety correlated negatively with increased numbers of patients (r=-0.44, p=0.0006) and higher percentage of patients located side rooms (r=0.63, p<0.0001). We found a significant relationship between perceptions of safety and the percentage of staff with a specialist critical care course (r=0.42. p=0.0001).
Existing staffing models, which are primarily influenced by staff-to-patient ratios, may not be sensitive to patient need. Other factors may be important drivers of staff perceptions of safety and should be explored further.
探讨重症监护病房医护人员对床边专业报告（BPR）感知的安全性，以及 BPR 安全性、人员配备、患者和工作环境特征之间的关系。
对自我记录的员工对轮班安全性的感知和常规收集的数据进行探索性研究。
一家由 70 张重症监护病床组成的大型教学医院。
所有在成人重症监护病房工作的临床医护人员。
员工记录连续 29 天的轮班是否“安全、不安全或非常不安全”。我们探讨了这些感知以及它们与人员配备、患者和环境特征之间的关系。
在连续 29 天内记录了 2836 份 BPR 评分（应答率为 57.7%）。医护人员对安全性的感知因人而异，甚至在同一班次内也是如此。安全性感知与人员配备的两个指标（每患者护理小时数（r=0.13，p=0.108）和 Safecare Allocate（r=-0.19，p=0.013））之间没有相关性。我们发现安全性感知与 3 级（最病重）患者的比例之间存在显著正相关（r=0.32，p=0.0001）。安全性感知与同一班次 1 级患者的比例之间呈显著负相关（r=-0.42，p<0.0001）。安全性感知与患者数量的增加呈负相关（r=-0.44，p=0.0006），与侧房患者比例的增加呈正相关（r=0.63，p<0.0001）。我们发现安全性感知与具有重症监护专业课程的员工比例之间存在显著关系（r=0.42，p=0.0001）。
现有的人员配备模式主要受医护人员与患者比例的影响，可能无法满足患者的需求。其他因素可能是影响员工对安全性感知的重要驱动因素，应进一步探讨。
