Staffing with disease-based epidemiologic indices may reduce shortage of intensive care unit staff during the COVID-19 pandemic

PURPOSE: Healthcare worker (HCW) safety is of pivotal importance during a pandemic such as Coronavirus Disease 2019 (COVID-19), and employee health and well-being ensures functionality of healthcare institutions. This is particularly true for an intensive care unit (ICU) where highly specialized staff cannot be readily replaced. In the light of lacking evidence for optimal staffing models in a pandemic, we hypothesized that staff shortage can be reduced when staff scheduling takes the epidemiology of a disease epidemic into account. METHODS: Various staffing models were constructed and comprehensive statistical modeling performed. A typical, routine staffing model was defined that assumed full-time employment (40 hours/week) in a 40 bed ICU with a 2:1 ratio of patients to staff. The pandemic model assumed staff worked 12-hour shifts for 7 days every other week. Potential in-hospital staff infections were constructed for a total period of 120 days with a probability of 10%, 25%, and 40% being infected per week when at work. Simulations included the probability of infection at work for a given week, of fatality once infected, and the quarantine time, if infected. RESULTS: Pandemic-adjusted staffing significantly reduced workforce shortage and the effect progressively increased as the probability of infection increased. Maximum effects were observed at week 4 for each infection probability with a 17%, 32%, and 38% staffing reduction for an infection probability of 0.10, 0.25, and 0.40, respectively. CONCLUSIONS: Staffing along epidemiologic considerations may reduce HCW shortage by leveling the nadir from affected workforce. Although this requires considerable efforts and commitment of staff, it may be essential in an effort to best maintain staff health and operational functionality of healthcare facilities and systems.