Patient FIRST: Staffing

Clinical and executive feedback from the workshops we held in 2021

Suggested processes and ideas for improving patient safety

Make use of recognised standards and regional benchmarking

Use recognised standards and regional benchmarking, such as the baseline emergency staffing tool (BEST-RCN) for:

• staffing
• assessing the skills mix throughout the department.

Consider new or extended roles in EDs

Consider new or extended roles in emergency departments including:

• allied health professions (AHPs)
• scribes
• housekeepers
• additional admin staff
• receptionists and admin staff
• physician's assistants (PAs)
• paramedics
• army medics
• security
• porters
• medical students.

Create or rethink use of models and job plans

Acute trusts can create or rethink existing models and job plans for non-ED consultants and workforce to:

• place appropriate value on generalists and medical on call
• ensure consultants are available to treat the increasing numbers of complex presentations. For example, those with multi-organ disease
• equate the focus on urgent and emergency care with elective care
• support specialists to provide 'in-reach' and senior specialty review to ED
• support admission avoidance.

Support staff wellbeing

Support staff by providing robust, clearly signposted ways to report and manage moral injury.

Introduce new initiatives that promote and support ED staff wellbeing.

ED nursing capacity and skill sets

A real-time overview of nursing capacity and deployment across the ED allows you to:

• safely prioritise patients, to deliver safe and timely care to the sickest patients in the ED
• retrospectively look for correlations between staffing patterns and adverse incidents
• assess and optimise the deployment of nurses and specific skill sets across the department.

Your capacity and deployment plans should meet the national standards.

Examples of good practice

Staff feedback/temperature check

Staff are the department’s most valuable commodity. Organisations can collect staff feedback on a regular and frequent basis. The responses then need to be acknowledged and responded to as appropriate and able.

Staff feedback indicates the 'heat' or stress levels of the department. Understanding this can help management make informed decisions and take action.

Good examples of live monitoring exist in other industries. This is relatively easy to put in place. For example, staff feedback could be checked, recorded and included as part of regular ED huddles.

Workshop attendees also supported introducing exit surveys for leaving staff.

Mandatory training

A high-quality training programme with good compliance levels is essential for safety-led organisations.

Safety-led trusts provide:

• mandatory inductions for all ED staff, including locums
• mandatory ongoing training that is clinically relevant
• protected time to enable mandatory training and other development needs.

Example datasets that can drive possible safety improvements

• staff sickness rates
  • Staff sickness rates - and changes in those rates – can be regularly monitored and interpreted on a local and national level.
  • Rates can also be assessed for correlation with staff satisfaction, recruitment and retention.
• Undertake regular reviews of establishment requirements for all staff groups
• Reviews of consultant staffing levels to make sure they follow Royal College of Emergency Medicine (RCEM) and the Royal College of Paediatrics and Child Health (RCPCH) guidance
• Consultant vacancies
• Locum use at all grades
• Nursing staffing numbers and compliance with national guidance including those for paediatric nurses
• Nursing staff vacancies and use of bank and agency staff
• Review of incident reports raising concerns about number and skill mix of staff