WASHINGTON — A new rapid expert consultation from a standing committee of the National Academies of Sciences, Engineering, and Medicine outlines considerations for clinical staffing needs during the implementation of Crisis Standards of Care (CSC), including adjusting staff responsibilities, providing “hazard pay” to staff, ensuring adequate time off, offering child care and other benefits, and leveraging health care coalitions to ensure appropriate transfer of patients between hospitals. This rapid expert consultation builds on previous National Academies reports on CSC, including a March 28 rapid expert consultation on the topic.

With nearly 40 states being designated COVID-19 “hot spots,” the availability of qualified critical care and respiratory therapy staff continues to be a problem for hospitals. In some cases, even if existing staff may be capable of working additional hours, they may have concerns about spreading the disease to family members or being at higher risk for complications themselves, or they may be uncomfortable about the availability of effective personal protective equipment.

The rapid expert consultation says health care systems should consider a number of staffing strategies, including moving clinical staff from lesser-affected regions or from one facility to another; adjusting the ratio of critical care nurses to patients; using local and national contract agencies for short-term support; and tailoring the job responsibilities of existing staff. Respiratory therapists in particular are in significant demand and do not have correlate staff who can perform in their roles, the authors noted. Their responsibilities should be closely examined to prioritize ventilator set-up and address the needs of ventilated patients, since other staff may not be accustomed to ventilator operations. Staff policies should also describe how staff who are exposed to COVID-19 could still contribute to telemedicine or remote training — if they are physically and psychologically able to do so.

The authors of the rapid expert consultation also outlined a series of questions that could guide hospitals and health care coalitions in assessing staffing needs. Staffing numbers alone are not adequate for understanding needs and should be accompanied by insights into how staff are being asked to spend their time. Issues of racial equity should also be included in considerations about the well-being of staff and care of patients.

The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.

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