Hospital Dr News

New guidance defines safe doctor staffing levels in hospitals

A Royal College has issued ground-breaking guidance on safe medical staffing levels in hospitals.

The guidance, by the Royal College of Physicians, will allow trusts to map their current staffing levels against the recommendations to ensure they are providing safe care for patients.

Guidance on Safe Medical Staffing has assessed in detail the time needed to diagnose, treat and manage patients in a variety of hospital settings. 

The working party report divides clinicians into three clear tiers based on levels of knowledge, experience and responsibility, and calculates how much time is needed from clinicians in each tier. 

It ranges from Tier 1, which includes foundation year doctors, to Tier 3, which includes consultants.

The report then applies the tier model to hospital care settings, such as the medical assessment and admission team, and the medical ward team.

It makes specific recommendations for the amount of hours needed from each tier of clinician in each setting.

In the medical assessment and admission team, for example, to assess 10 patients satisfactorily, it will require 15 hours of Tier 1 time; 9.5 hours of Tier 2 time; and, 4.25 hours of Tier 3 time.

This is based on a system of consultant-led care. There might not be an immediate consultant presence in the emergency department and acute medical unit (AMU) but there would be consultant-led post-take ward rounds.

These figures would be 15 hours of Tier 1 time; 7 hours of Tier 2 time; and, 6.5 hours of Tier 3 time – if the system employed involved partly consultant delivered care, with consultant presence and early involvement in the emergency department and AMU.

The calculations in the report will enable hospitals to map their current provision against the recommendations to ensure they are able to provide safe care for patients.

RCP president Professor Dame Jane Dacre said: “This report results from a detailed analysis, completed by physicians experienced in delivering care for acutely ill patients. It provides a tool which can be used to calculate a safe level of medical staffing.

“We hope to work with NHS colleagues to refine the method in different hospitals, so that it can help ensure that patients are not put at risk by medical workforce shortages.”

The RCP will work with hospitals to pilot the recommendations in real-life situations.

 RCP registrar and president-elect Dr Andrew Goddard said: “The variation in the numbers of doctors per bed in the UK is staggering. At last we have a way we can benchmark medical staffing levels to ensure that patients will know if the wards they are on have safe staffing levels.”

Dr Kathy Mclean, Executive Medical Director at NHS Improvement, added: “Having the right medical staff with the right skills in the right place and at the right time is vital for providing patients with high quality, responsive care.

“This report is a useful addition to the ongoing research into how the NHS can achieve safe and sustainable staffing across all its health settings. We will now work with the RCP on the issues raised by this report.”

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