The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

A STATE-WIDE SURVEY OF PATIENT SAFETY ISSUES AND STAFFING LEVELS IN HOSPITAL-BASED RESPIRATORY CARE DEPARTMENTS.

Daniel J. Grady1, Floyd Boyer2, Jospeph Coyle3, Ronald Perkin4, Terrence Smith1, Todd McCarl1, Myra Stearns5, Garry Dukes6; 1Respiratory Care, Mission Health System, Asheville, NC; 2NCRCB, North Carolina Respiratory Care Board, Raleigh, NC; 3Respiratory Care Program, University of North Carolina Charlotte, Charlotte, NC; 4Respiratory Care, Vidant Health System, Greenville, NC; 5Respiratory Care Department, Carolinas Medical Center South, Pineville, NC; 6Respiratory Care Department, Carolinas Medical Center Northeast, Concord, NC

Background: Previous studies have identified an inverse correlation between staffing levels and patient mortality in Nursing units1. The North Carolina Respiratory Care Board (NCRCB) followed up on patient safety issues brought before the Board; where (1) licensed therapists had reported that mathematically impossible workloads resulted in patient care issues; and (2) managers expressed concerns regarding inaccurate comparative data from external consulting companies used to determine staffing levels. These issues were investigated by means of a state-wide survey of Directors/ Managers of Respiratory Care Departments. Methods: A voluntary, anonymous survey was developed and sent to all Directors/Managers of Hospital-based Respiratory Care departments throughout North Carolina. The survey focused on the metrics in use to determine staffing levels, presence or absence of adequate staffing, perceived causes of chronic understaffing, and management reports of patient safety issues resulting from understaffing in the acute care hospital setting within the past year. Results: A total of 35 (n=35) licensed Directors/Managers of Respiratory Care departments completed the survey, for a state-wide 26 % response rate. Reported patient safety issues are summarized in the table below, which follows this abstract. Key findings included 30% of departments reported being chronically understaffed, 75 % of hospitals were using metrics provided by external consultants which the AARC specifically recommends to not use, and more than 50% of the Directors/Managers rated the quality of comparative data provided by proprietary hospital consultants as “poor”. Conclusions: This survey has identified serious, reported patient safety issues associated with the metrics, productivity targets, and proprietary comparative data used to determine Respiratory Care department staffing levels. These safety issues are significant and indicate anecdotal reports of possible patient harm. As a result of the magnitude of these findings, the NCRCB has developed a position statement which states that the determination of safe staffing levels is within the scope of practice of licensed Directors/ Managers of Respiratory Care services. Further, it is recommended that this survey be expanded nation-wide, and that national standards are developed to ensure that patient safety is ensured by safe staffing levels. Sponsored Research - None State-Wide Reported Patient Safety Issues Due to Under-Staffing Respiratory Care Departments References: Needleman J. et. al. Nurse Staffing and Inpatient Hospital Mortality. N Engl J Med 2011; 364: 1037-1045, March 17, 2011.