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Patient Safety in an Understaffed Care Setting

By Jock Hoffman, CRICO

Related to: Ambulatory, Communication, Emergency Medicine, Primary Care, Nursing, Obstetrics, Publications, Surgery, Teamwork Training

COVID-19, burnout, the big quit, and myriad other reasons have left health care delivery systems short-handed. The scramble to fill shifts and service employee gaps means that patients are increasingly frustrated and, perhaps, at greater risk of a misstep in their care. While others try to figure out how to better attract and retain staff, those who are on the front lines—veterans, new hires, and temps can look to a few basic practices to protect themselves and their patients.

The primary strategy that any organization facing staffing challenges can implement to reduce the risk of medical errors is to foster a culture of trust and collaboration. No matter their length of service, all staff should feel comfortable speaking up about safety concerns. More specifically, health care providers should consider sharing these practices for addressing workload and workflow concerns.


  Promote Safety, Support, and Teamwork

  • Model and support a culture of trust so staff feel comfortable seeking advice or backup help
  • Conduct a quality improvement review of onboarding and temp orientation systems
  • Convene service line or unit staff to brainstorm on gaps and potential solutions
  • Ensure that all staff are aware of your most frequently invoked policies/protocols
  • Consider data-driven scheduling models to accommodate variation in patient demand
  • Use regular safety huddles to encourage team communication around patient, staff, and equipment
  • Ensure that escalation policies are clear about the criteria that trigger a call for help
  • Confirm that paging and backup systems reliably enable timely consults and orders
  • For shifts commonly staffed by the same (temp) providers, consider “need to know” training and refreshers, e.g., for layout and equipment locations
  • Evaluate protocols to provide safe monitoring of patients (e.g., post-op status, medication tolerance, falls risk) during all shifts, with consideration for accommodations due to understaffing
  • Look downstream when scheduling patients for elective procedures to ensure a safe timeline for post-procedure monitoring and care


If you are “open for business,” then even patients who may be fully aware of, and empathetic about, staffing shortages will expect the same level of care safety as before. A culture of collaboration and honest communication are critical to meeting those expectations.

February 28, 2022
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