Date of release: Monday, March 31, 2014

Professor Elizabeth WestPatients in Intensive Care have a better chance of survival if there are more doctors and nurses working on the unit, new research shows.

The study, led by the University of Greenwich, also shows that the survival of the most severely ill patients is most affected when there are insufficient nurses.

Researchers have been able to separate out staffing levels from other factors, such as workload and how ill patients are, for the first time after examining nearly 40,000 patient records and data from 65 ICUs in the UK.

Professor Elizabeth West, pictured, who led the research, says: “This is timely because the public are concerned about the ability of the NHS to provide safe and compassionate care. Recent catastrophic failures such as events at Mid-Staffordshire have highlighted the importance of staffing levels to patient survival, and this study has reinforced that message.”

This is the first study of patient survival in ICUs to look at the numbers of doctors as well as nurses. Professor West says that doctors and nurses work closely together and function as a team on ICUs more than on other wards: “Future studies need to see the whole picture and examine how the multi-disciplinary team works together.” It is also the first study to show that there is a sub-group of patients – those who are the most severely ill – who are most affected by low levels of nurse staffing.

She believes the new evidence will be essential to the National Institute for Health and Care Excellence (NICE) when it draws up guidance on safe staffing levels later this year.

Story by Public Relations


Editors’ notes

1. The report is ‘Nurse staffing, medical staffing and mortality in Intensive Care: an observational study’ published by the International Journal of Nursing Studies (2014):

The authors are Elizabeth West, University of Greenwich; David N. Barron, University of Oxford; David Harrison, Intensive Care National Audit & Research Centre; Anne Marie Rafferty, King’s College, Kathy Rowan, Intensive Care National Audit & Research Centre and Colin Sanderson, London School of Hygiene and Tropical Medicine.

2. Data came from two sources: the Intensive Care National Audit & Research Centre (ICNARC) which co-ordinates the Case Mix Programme – the national clinical audit of patient outcomes from adult ICUs; and from a survey of the organisational characteristics of ICUs conducted by the Audit Commission, both from 1998. New modelling techniques, and a different approach to the data, have enabled the researchers to reach different conclusions from those reported by the Audit Commission in their 1999 report, ‘Critical to Success’. That report showed wide variation in staffing levels across UK ICUs, and wide variation in patients’ survival chances, but was unable to show a relationship between higher numbers of staff and better patient outcomes. Although the dataset is now ‘old’, it is the best currently available on staffing and outcomes in ICU. This emphasises the urgent need for a prospective study to produce evidence that can be used by managers to ensure optimum staffing levels.

3. Elizabeth West has been Professor of Applied Social Research in the School of Health and Social Care at Greenwich since 2007. She graduated from the University of Edinburgh with an integrated degree in Nursing and Social Science (Magna Cum Laude), won a Fulbright scholarship to study for an MSc in mental health nursing at the University of California, San Francisco, and gained over seven years clinical experience in psychiatry at Royal Edinburgh Hospital. She returned to the US to gain an MA and PhD in sociology at Cornell University. She worked in the Department of Public Health at the University of Oxford, the RCN Research Institute and at the London School of Hygiene and Tropical Medicine, before taking up her current role.