An assessment of the staffing level required for a high-dependency unit

High-dependency units are increasing in number and becoming an ever more important part of a hospital's facilities. The optimum staffing ratio is unknown, but the Department of Health and the Intensive Care Society recommend a level of one nurse to two patients. We recorded Therapeutic Intervention Scoring System-28 scores and Nurse Dependency Scores for all admissions to our adult, general high-dependency unit over 7 months. We found a weak correlation between the nurse dependency score and the Therapeutic Intervention Scoring System-28 score. The median Therapeutic Intervention Scoring System-28 score was 23 points (interquartile range 19-26), and the median Nurse Dependency Score was 1.0. These results are approximately two-thirds of those for European intensive care units. We conclude that a nurse-to-patient ratio of 1:2 may be insufficient for an adult general high-dependency unit, and would recommend a nurse-to-patient ratio of 2:3.