Agency work in intensive care Impact of temporary contract work on patient care in intermediate care and intensive care units

Background Temporary contract workers are used for the nursing care of intensive care patients, usually by service providers in the sense of temporary employment. If or how temporary contract work has an impact on patient care has scarcely been investigated so far. Aim The aim of this systematic review is to describe the available research results on the use of temporary workers in nursing care in intensive and intermediate care units and to summarize the prospective effects on patient outcomes. Method Seven databases were systematically searched for English and German language articles using Boolean operators and evaluated according to the PRISMA schema. References of included studies were included in the search and the quality of all included studies was evaluated according to the Hawker criteria. Result From a total of 630 datasets viewed, 1 qualitative and 2 quantitative studies were identified and analyzed. The findings of the quantitative studies indicated that the probability of the occurrence of catheter-associated infections can increase with the use of temporary workers, but is more dependent on the size of the unit: For each additional bed, the probability of VAP increases by 14.8% (95%-CI= 1.032-1.277,p= 0.011). However, trends for a decrease in the sepsis rate as soon as fewer temporary workers (hours/patient) were deployed in the intensive care unit (ICU) could not be confirmed. Conclusion In the few available studies no evidence was found that the use of temporary workers in intensive care units (ICU) and intermediate care units (IMC) has a significant impact on patient outcomes; however, evidence was found that individual qualifications and working conditions have an influence on outcomes. Further studies should consider what ratio of permanent to temporary workers should be considered uncritical, what qualifications temporary workers should have and to what extent these can be checked.