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Staffing is the single biggest cost component in the critical care budgets. Due to the fluctuation in both bed occupancy and the level of care needs, nursing staff requirement can vary considerably from day to day. This makes the traditional ‘fixed roster’ staffing system inefficient, costly and potentially unsafe. In this study, we used the existing bed occupancy data to test the viability two ‘dynamic’ workforce management models. Nursing requirement data were prospectively collected over one year at a thirty-two-bed critical care unit. Using mathematical models, we then tested the concept of two alternative workforce management models and compared the level of staffing, as well as the estimated cost per year. The first was an ‘on-call’ model, which was a two-tier roster with a standard staffing level and an additional on-call component; the second was a ‘predictive’ model, which estimated the staffing requirement based on the bed occupancy a few days prior. Single centre study in a busy district general hospital with a 32-bed critical care unit. The number of days with safe staffing levels and the cost of the alternative workforce management models. Data were collected over 331 days. The on-call model was estimated to cost 16% less per year (£431,320, or 2,630 nurse-shift equivalent) compared to the fixed roster, while fulfilling the adequate staffing standards in 97% of the days. While the predictive model could also be used to improve the workforce efficiency, this was overall less efficient than the on-call model. The modelled data suggests that the implementation of an ‘on-call’ model in critical care nursing rostering could potentially improve coverage and appear to be cost effective.

The COVID-19 pandemic had a significant effect on healthcare globally. Additional pressure created by coronavirus adversely affected the mental health and psychological well-being of healthcare workers, leading many to question their desire and willingness to continue working in healthcare. This study aimed to identify predictors for career change ideation among healthcare professionals in two countries; Lithuania and the United Kingdom amid the coronavirus pandemic. In total, 610 healthcare professionals from Lithuania and the UK (285 and 325, respectively) participated in a survey from May to August 2020. Psychological distress and psychological well-being were measured using the self-report scales “DASS-21” and “WHO-5”. Almost half of the sample (49.2%), 59.6% and 40.0% in Lithuanian and the UK, respectively, exhibited career change ideation, the country effect was significant (AOR = 2.21, p < 0.001). Stronger ideation to leave healthcare was predicted by higher levels of depression (AOR = 1.10, p = 0.005), stress (AOR = 1.10, p = 0.007), anxiety surrounding inadequate personal protective equipment (AOR = 2.27, p = 0.009), and lower psychological well-being scores (AOR = 1.10, p = 0.007). We conclude that psychosocial support must be provided for healthcare professionals to prevent burnout and loss of staff amid the pandemic.

Major international guidelines state that norepinephrine should be used as the first-line vasopressor to achieve adequate blood pressure in patients with hypotension or shock. However, recent observational studies report that in the United Kingdom and Australia, metaraminol is often used as second line medication for cardiovascular support.The aim of this study was to carry out a systematic review of metaraminol use for management of shock in critically unwell patients and carry out a survey evaluating whether UK critical care units use metaraminol and under which circumstances.A systematic review literature search was conducted. A short telephone survey consisting of 6 questions regarding metaraminol use was conducted across 30 UK critical care units which included a mix of tertiary and district general intensive care units.Twenty-six of thirty contacted centres responded to our survey. Metaraminol was used in 88% of them in various settings and circumstances (emergency department, theatres, medical emergencies on medical wards), with 67% reporting use of metaraminol infusions in the critical care setting. The systematic literature review revealed several case reports and only two studies conducted in the last 20 years investigating the effect of metaraminol as a stand-alone vasopressor. Both studies focused on different aspects of metaraminol use and the data was incomparable, hence we decided not to perform a meta-analysis.Metaraminol is widely used as a vasopressor inside and outside of the critical care setting in the UK despite limited evidence supporting its safety and efficacy for treating shock. Further service evaluation, observational studies and prospective randomised controlled trials are warranted to validate the role and safety profile of metaraminol in the treatment of the critically unwell patient.

A woman in her 50s was admitted to the intensive therapy unit with acute hypoxaemic respiratory failure secondary to COVID-19 pneumonitis. The patient was intubated on admission and worsening gas exchange necessitated multiple rounds of proning . She later improved, and her ventilation was switched to spontaneous mode. However, the patient started to develop air trapping with subsequent respiratory and cardiovascular compromise. Routine investigations showed no clear cause for her sudden deterioration and a suction catheter passed easily through the endotracheal tube. Bronchoscopy revealed mucinous/phlegmatic membranes had developed across the inner diameter of the endotracheal tube. This had created a one-way valve that allowed positive pressure ventilation through the tube into her lungs but only allowed a fraction of air to passively escape in expiration. This case report highlights a less commonly regarded complication associated with long-term intubation and lack of circuit humidification in the context of productive lung pathology.