Exploratory study of staff perceptions of shift safety in the critical care unit and routinely available data on workforce, patient and organisational factors.

ObjectivesTo explore bedside professional reported (BPR) perceptions of safety in intensive care staff and the relationships between BPR safety, staffing, patient and work environment characteristics.DesignAn exploratory study of self-recorded staff perceptions of shift safety and routinely collected data.SettingA large teaching hospital comprising 70 critical care beds.ParticipantsAll clinical staff working in adult critical care.InterventionsStaff 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.Outcome measuresRelationships between BPR safety and staffing, patient and work environment characteristics.Results2836 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).ConclusionExisting 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.