British intensive care units are so routinely understaffed patients are at risk of poor care, ICU doctors warn in a report from the Faculty of Intensive Care Medicine (FICM).
The Guardian reports that the UK-wide survey found that four out of five intensive care consultants believe shortages of doctors and nurses has left their unit too “stretched” to provide the best possible treatment. The unprecedented demands Covid placed on ICU staff means that one in seven of the NHS’s 2,500 intensive care consultants is thinking of quitting or switching to another role amid widespread stress and burnout.
Key Findings from the FICM report include:
45% of respondents have seen a permanent increase in the critical care capacity of their directorates. However, when asked if they consider any increase in capacity to be adequately staffed only 18% of respondents agreed.
60% of respondents reported that their units are still attempting to follow the Guidelines for the Provision of Intensive Care Services (GPICS) but 54% of respondents have seen some relaxation of those standards including to their medical staffing.
80% of respondents increased their working hours, and 71% report covering sick consultant colleagues. Future uncertainties affect the wellbeing of the Faculty’s fellows and members. How hospital structures support those working in critical care is vitally important for both recruitment and retention.
88% of respondents had leave cancelled. Work/life balance is extremely important. Whilst the vast majority of respondents were happy to deliver the needed increase in work in the first wave, to do this over subsequent waves of the pandemic becomes increasingly difficult for individuals and their family. Supporting professional activities and agreed job plans will be even more important in subsequent COVID-19 waves.
“Sixty per cent of units have nursing vacancies and 40% of units are forced to close beds on a weekly basis due to staff shortages. So it is a widespread problem”, said Dr Alison Pittard, the dean of the faculty, which represents intensive care staff.
Key Recommendations from the report:
GPICS standards exist for reasons of best care, safety and governance. Units should be attempting to adhere to them or working towards achieving them.
Inability to meet GPICS standards needs to be brought to the attention of management structures within hospitals and plans for addressing deficiencies identified and implemented.
Supporting and maintaining the wellbeing of critical care staff is vitally important. Not only for recruitment by attracting multi-disciplinary team members in, but also for their retention in the specialty. Staff must not be taken for granted and listening to the voices from the frontline is only the start of this process.
Enhanced Care recommendations, written and promoted by the Faculty, will allow for greater flexibility in future responses to surges in demand as well as safer care for those needing a higher level of care. Critical Care Directorates should make the case widely within their hospitals for enhanced surgical and medical care.
[link url="https://www.theguardian.com/society/2020/nov/22/nhs-patients-at-risk-as-icus-routinely-understaffed-doctors-warn"]Full The Guardian report[/link]
[link url="https://www.ficm.ac.uk/sites/default/files/voices_from_the_frontline_of_critical_care_medicine.pdf"]Full Voices from the Frontline of Critical Care Medicine report[/link]