globally, there were over 1.3 million confirmed Covid-19 cases and 55 000 cases in the United Kingdom (WHO). 1 The Covid-19 pandemic is the greatest challenge faced by the National Health Service (NHS) to date. Recent data from the United Kingdom-based Intensive Care and National Audit Research centre (ICNARC) database 2 suggests patient mortality rates are almost double those of common viral pneumonia seen in intensive care unit (ICU) patients (50.1% vs 22.4%). In ventilated patients, ICU mortality is even higher (67%), 2 but interpretation should be cautious until further outcomes of this population become known. Severity of respiratory failure and high contagion index of SARS-Cov-2 has caused unprecedented patient numbers needing a high-dependency unit (HDU) or ICU. 3 In response, NHS ICUs have nationally increased bed capacity, 4 utilized staffing models not seen before, 5 and changed medical strategies. Previous pandemic preparedness models have highlighted "fourSs" that include: space (beds), staff (clinicians and operations), stuff (physical equipment), and system (co-ordination). 6 The Systems Engineering Initiative for Patient Safety (SEIPS) human factors model potentially offers a more comprehensive framework by focusing on health care structures, relationships, and processes. 7 It consists of five key domains: person, task, tools and technology, environment, and organization. The SEIPS model 7 may facilitate a pragmatic approach in provisioning for pandemic preparedness, incorporating additional elements of task, tools, and technology. The systematic framework of this model provides the opportunity and means to examine the Covid-19 pandemic while utilizing real-time experiences from the frontline. How to cite this article: Lumley C , Ellis A , Ritchings S , Venes T , Ede J . Using the Systems Engineering Initiative for Patient Safety (SEIPS) model to describe critical care nursing during the SARS-CoV-2 pandemic (2020).
Background The Covid-19 pandemic has highlighted weaknesses in the National Health Service critical care provision including both capacity and infrastructure. Traditionally, healthcare workspaces have failed to fully incorporate Human-Centred Design principles resulting in environments that negatively affect the efficacy of task completion, patient safety and staff wellbeing. In the summer of 2020, we received funds for the urgent construction of a Covid-19 secure critical care facility. The aim of this project was to design a pandemic resilient facility centred around both staff and patient requirements and safety, within the available footprint. Methods We developed a simulation exercise, underpinned by Human-Centred Design principles, to evaluate intensive care designs through Build Mapping, Tasks Analysis and Qualitative data. Build Mapping involved taping out sections of the design and mocking up with equipment. Task Analysis and qualitative data were collected following task completion. Results 56 participants completed the build simulation exercise generating 141 design suggestions (69 task related, 56 patient and relative related, 16 staff related). Suggestions translated to 18 multilevel design improvements; five significant structural changes (Macro level) including wall moves and lift size change. Minor improvements were made at a Meso and Micro design level. Critical care design drivers identified included functional drivers (visibility, Covid-19 secure environment, workflow, and task efficiency) and behavioural drivers (learning and development, light, humanising intensive care and design consistency). Conclusion Success of clinical tasks, infection control, patient safety and staff/patient wellbeing are highly dependent on clinical environments. Primarily, we have improved clinical design by focusing on user requirements. Secondly, we developed a replicable approach to exploring healthcare build plans revealing significant design changes, that may have only been identified once built.
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