SCCM Resource Library-Not so Ancillary: Advocating for Adequate Allied Healthcare Professional Staffing

Video Transcription

Hello, I'm Ashley DePriest. I'm a registered dietitian and the clinical nutrition manager at WellSTAR Kennestone Regional Medical Center in Marietta, Georgia. I am honored today to  be speaking to you on the subject, not so ancillary, advocating for adequate allied health care professional staffing. A foundational aspect of high quality critical care is the  use of multidisciplinary health care teams that leverage specialized training of each respective discipline to improve patient care. Critical care allied health care team members  include occupational therapists, dietitians, respiratory therapists, physical therapists, health care coordinators and social workers, and speech-language pathologists and more.  These team members are vital for providing quality care in the ICU, including implementation  of various evidence-based processes such as the ABCDEF bundle, volume-based feeding, early vent weeding protocols, and more. We know, however, that ancillary staff are more than  just ancillary. These team members are integral in the care and improvement of critically ill patients. I think everyone can agree that we need these team members on the ICU. But  the question is, how do we determine the right number of ancillary staff to ensure safe and  optimal patient care that is also cost-effective? We do have some data to help guide staffing.  According to one study from the Journal of the Academy of Nutrition and Dietetics published in 2015, dietitians should see around 2.42 patients per hour of patient care. A 2016  study published in the Canadian Journal of Respiratory Therapy described their staffing  patterns of five patients for every one respiratory therapist. And a U.S. nationwide survey published  in 2015 in Physical Therapy described 6.3 physios for every 100 ICU beds. You can visit these articles using the QR links below. Let's take a closer look at some of this data. The  dietitian data specifically was self-reported. Approximately 77% of the day was spent with direct patient care, equating to 15 patients per day on average. The data included large  heterogeneous sample size, including every geographic region of the U.S. However, what was not included is the acuity level of the patients. In other words, this was not an  ICU-specific study. They also didn't mention whether a nutrition-focused physical exam were being performed or how often this might be performed. A nutrition-focused physical exam  takes up a lot of time for registered dietitians and isn't something that has always been routine  practice. A closer look at the respiratory therapist data shows that it was also self-reported  data. This study was specific to the ICU, looking at vent patient care only, and also included only  teaching hospitals. A benefit to this study was that they did include three waves of data  collection in order to cover various seasons, such as influenza season. They did find that a  lower-than-expected number of RTs were routinely engaging in the highest scope of practice. For  example, only 45% of RTs surveyed were routinely performing intubations, 34% routinely inserting  arterial lines, and only 32% routinely procuring arterial blood gases. They also mentioned that  data was not collected regarding the full scope of an RT practice. One example of something that  was left out were bronch procedures. Physical therapy data was also self-reported. They did  ask specific critical care questions and included case scenarios related to critically ill patients.  They also included every geographic region in the U.S., including 47 of 50 states. And one  advantage to this data was that they asked about staff perceptions of barriers to adequate care,  and as we could guess, insufficient staffing was one of the biggest barriers and overwhelmingly  the most common barrier recorded. They also mentioned department prioritization policies as being a barrier to adequate care, as well as inadequate consultation criteria.  One piece of the physical therapy data mentioned that involvement was more likely to be based on the medical intervention rather than characteristics of patients. And academic  hospitals were more likely to have the physical therapist involved and have them performing higher-intensity mobilization on the sicker patients. So what's missing? Unlike a lot of  the pharmacy data that's available now, much of the ancillary data around staffing is looking  at the current picture, which may not always be the ideal scenario. For example, none of these groups are describing situations in which ancillary staff are performing at the height  of their scope of practice. Additionally, none routinely included any meaningful outcome data.  So how do we move from a more ancillary team to a more integrated critical care team? I think one  of the first things we need to focus on is ensuring that our staff are trained to and  performing at their highest scope of practice. We saw this mentioned in the respiratory therapy data,  especially as it related to things like arterial line placement and blood gas drawing, but it can  also apply to your registered dieticians. I think one example would be feeding tube placement. This  would not only apply to your dieticians, but could also help alleviate some of your nursing  staffing and being able to have multiple options for placing feeding tubes. I think another thing  that we could look at is rethinking our staffing models. So for registered dieticians, as you saw,  we really look at how many patients per day are we seeing. That's been our productivity model for  years and years, but that doesn't always correlate with outcomes. So really trying to shift our  thinking to how do we measure the work we're doing by how it affects our outcomes, rather than just a sheer number of patients we're assessing each day. So for example, thinking  about individual interventions rather than one patient. So you may spend 15 minutes doing one  intervention on a patient, but that intervention was very impactful, but you're only getting kind  of productivity credit for that one patient. Whereas you may spend two minutes on five patients  doing several very simple interventions that get counted as a more productive measure. But again,  those interventions may not have much to do at all with outcomes. It may just be kind of  checking your box as far as documentation. And then finally, I think we need more outcome data,  specifically related to the functions of our ancillary staff. Again, sticking with the example  of the registered dietician, we have a lot of opportunity to shift our thinking and how we're  measuring what we're doing. And I think there's a lot of opportunity there to be able to connect  that specifically to outcomes. So for example, especially in our ICUs, there's a lot of things  that we do, such as adjusting to feed orders to help either prevent over or under feeding, both of which can impact things such as vent weaning time, infection rates, blood sugar  management, all of those things. I think another thing that we help do is also coordinate some of  the discharge planning for patients. So making sure that whatever they're on and wherever they're  going after the ICU, whether it's to another unit or to another hospital, making sure that those  plans of care get continued wherever they end up after the ICU is a very, very vital part of what  we do. And I know that other disciplines are involved in that as well. So connecting some of  those things to our outcome data, some of our daily tasks to the outcome data is very, very important in the future of our research and helping to justify our staffing in the ICU.  So thank you for your time today. I really appreciate the opportunity to speak to you about  staffing in the ICU. And I know we have a lot of work to do to really show in the data that  ancillary staff is really not that ancillary. I know we all know that the staff is not ancillary,  but I'm looking forward to seeing more and more discussion and talking more with everyone about  how do we continue to integrate our team into a more multi-professional group. So thank you again, and I look forward to speaking with you all.

Video Summary

In this video, Ashley DePriest, a registered dietitian and clinical nutrition manager, discusses the importance of adequate staffing for allied healthcare professionals in critical care settings. She emphasizes that multidisciplinary healthcare teams are crucial for improving patient care. DePriest provides data from various studies on staffing patterns for different professions, including dietitians, respiratory therapists, and physical therapists, highlighting the need for appropriate staffing levels. She also suggests focusing on training staff to perform at their highest scope of practice, rethinking staffing models, and collecting outcome data to justify staffing needs. Overall, she advocates for integrating ancillary staff into a more multi-professional team for optimal patient care.

Asset Subtitle

Administration, 2022

Asset Caption

A foundational aspect of high-quality critical care is the use of multidisciplinary healthcare teams that leverage the specialized training of each respective discipline. Evidence continues to demonstrate that the use of multidisciplinary critical care teams improves clinical outcomes. The level of healthcare professional staffing in the ICU correlates to patient outcomes and medical errors. It is clear that medical errors are independently associated with worse outcomes. However, the optimal practitioner-to-patient ratio needed to derive the benefits of this team-based approach and optimize safety is unknown. This session will feature a multidisciplinary panel who will communicate the synthesis of current evidence on optimization of healthcare professional-to-patient ratio for each discipline to educate ICU clinicians unfamiliar with these data and to spur the implementation of evidence-based healthcare professional-to-patient ratios in their ICUs.

Meta Tag

Content Type Presentation

Knowledge Area Administration

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Workforce

Year 2022

Keywords

adequate staffing

allied healthcare professionals

critical care settings

multidisciplinary healthcare teams

staffing patterns

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