The COVID-19 pandemic imposed extraordinary challenges on hospitals across the United States, resulting in critical issues including heightened patient acuity, increased mortality rates, and staffing shortages. These challenges compromised the quality of care provided and influenced healthcare workers’ perceptions regarding their ability to deliver safe patient care. This study aims to investigate the national trends in hospital workers' staffing and work-pace safety perceptions (SWSP) during the pandemic, examining the association between changes in hospital mortality rates and these perceptions. Furthermore, the analysis differentiates between intensive care unit (ICU) staff and their non-ICU counterparts to assess variations in perceptions.
A quantitative analysis was conducted using anonymized responses collected from the Hospital Survey on Patient Safety Culture, linked with mortality data from the Healthcare Cost and Utilization Project State Inpatient Databases. The study included over 258,000 responses from more than 400 hospitals within the pandemic timeframe, specifically from April 2020 to July 2022. The SWSP was evaluated using a composite measure of two items from the Hospital Survey on Patient Safety Culture focusing on staffing adequacy and work pace, categorizing perceptions into either negative/neutral or positive. Logistic regression models were utilized to explore the relationship between monthly mortality rates and SWSP, making adjustments for various individual and hospital-level factors. Additionally, the analyses were stratified to compare ICU and non-ICU settings.
The study revealed a consistent decline in SWSP nationwide, averaging a decrease of 3.5 percentage points each year. Notably, broader periods of increased mortality, particularly during the spikes attributed to the Delta and Omicron variants, corresponded with significant drops in these perceptions. A doubling of overall mortality was found to be associated with a 38% increased likelihood of negative or neutral SWSP (odds ratio [OR] = 1.38, standard error [SE] = 0.02, P < .01). When analyzed separately by setting, non-ICU patients showed a mortality doubling linked to a 14% increase in negative perceptions (OR = 1.14, SE = 0.02, P < .01), while ICU staff experienced a 40% increase in their odds (OR = 1.40, SE = 0.12, P < .01).
Throughout the pandemic, perceptions concerning staffing adequacy and the work pace among healthcare workers deteriorated, with notable differences between various staff positions. ICU personnel exhibited a greater sensitivity to surges in mortality rates compared to non-ICU staff. These findings highlight that SWSP serves as a crucial aspect of safety culture that can dynamically respond to systemic stressors. For healthcare leaders, these insights emphasize the importance of integrating external performance metrics with proactive monitoring of workforce perceptions. Addressing SWSP may offer early indicators of stress, inform resource allocation, and guide interventions designed to alleviate burnout, improve staff retention, and enhance resilience during crises.
COVID-19 pandemic; hospital workforce; intensive care; safety culture; staffing adequacy.
The authors declare no conflict of interest.