Title : Safe Staffing in the Emergency Care Setting in Ireland – Department of Health Ireland and University College Cork
Following the publication of the Framework for Safe Nurse Staffing and Skill Mix in General and Specialist Medical and Surgical Care Settings in Ireland (Department of Health 2018) (henceforth referred to as the Framework), the Taskforce set about applying the same methodology to the emergency care area:
This approach sets out to:
- Develop an evidenced based staffing (RN and HCA) and skill mix ranges framework,
- Set out clearly the assumptions upon which the staffing and skill mix ranges are determined,
- Make recommendations around implementation and monitoring of the framework,
- Consult with key stakeholders in the healthcare system and national and international experts.
Initial Pilot data collection took place in December 2018 using the BEST tool which incorporates the Jones Dependency tool. A second validation using like-for-like hospitals Internationally was also carried out, comparing WTE and skill mix.
The data from the four pilot sites was applied to 6 other evidence-based models of staffing to identify the most appropriate tool for the Irish context. The oversight was presented with the outcomes of this process and the Nursing Hours Per Patient Presentation (NHpPP) tool was selected as most relevant with agreement to test it in the pilot sites. This NHpPP tool acknowledges the intense nursing care required for the patients in the first hour of presentation to an ED setting and works on the assumption that this intensive requirement usually tapers down. The patient acuity and dependency during their time in the emergency care setting is also incorporated in to the tool.
The pilot sites have begun the process of recruitment to meet the recommend WTE of the NHPPP. The research team will carry out (time 2) data collection once the staffing adjustments have been made. In the meantime, the research team continue to receive secondary data from the pilot sites the will be included in the analysis post time 2 data collection.
This Framework was followed by the draft document titled: A Pilot to Implement the Framework for Safe Nurse Staffing and Skill Mix in the Emergency Care Area (Department of Health 2018). This document outlined the international evidence available, models of care currently in practice and set out a number of draft recommendations.
If the pilot is successful, the impact report based on the agreed outcomes will be recommended as the Framework for ED in the Irish setting, published and in line with Phase 1 rolled out nationally.