Intensivist physician-to-patient ratios and mortality in the intensive care unit

Abstract

Purpose A high daily census may hinder the ability of physicians to deliver quality care in the intensive care unit (ICU). We sought to determine the relationship between intensivist-to-patient ratios and mortality among ICU patients. Methods We performed a retrospective cohort study of intensivist-to-patient ratios in 29 ICUs in 10 hospitals in the United States from 2018 to 2020. We used meta-data from progress notes in the electronic health record to determine an intensivist-specific caseload for each ICU day. We then fit a multivariable proportional hazards model with time-varying covariates to estimate the relationship between the daily intensivist-to-patient ratio and ICU mortality at 28 days. Results The final analysis included 51,656 patients, 210,698 patient days, and 248 intensivist physicians. The average caseload per day was 11.8 (standard deviation: 5.7). There was no association between the intensivist-to-patient ratio and mortality (hazard ratio for each additional patient: 0.987, 95% confidence interval: 0.968–1.007, p = 0.2). This relationship persisted when we defined the ratio as caseload over the sample-wide average (hazard ratio: 0.907, 95% confidence interval: 0.763–1.077, p = 0.26) and cumulative days with a caseload over the sample-wide average (hazard ratio: 0.991, 95% confidence interval: 0.966–1.018, p = 0.52). The relationship was not modified by the presence of physicians-in-training, nurse practitioners, and physician assistants ( p value for interaction term: 0.14). Conclusions Mortality for ICU patients appears resistant to high intensivist caseloads. These results may not generalize to ICUs organized differently than those in this sample, such as ICUs outside the United States. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-023-07066-z.

Complicaciones y mortalidad en pacientes neurocríticos

“…La hipocalcemia fue el trastorno electrolítico más frecuente entre las alteraciones electrolíticas, representando 51,35% de todos los trastornos electrolíticos (n=19/37), coincidiendo con una revisión previa reportada en 2013 en pacientes críticamente enfermos (14) y una revisión reciente publicada este año relacionada con su manejo en el paciente crítico (15) . Igualmente representó el 29,23% (n=19/65) de todas las complicaciones en los pacientes neurocríticos.…”

Measures and Impact of Caseload Surge During the COVID-19 Pandemic: A Systematic Review*

“…The use of patient-to-physician or patient-to-nurse ratios was rare, possibly because those data are not always readily available. When available, studies showed inconsistent relationships between staffing ratio and mortality during the pandemic as with prepandemic studies (51–53). In Swiss ICUs, there was no difference in mortality when the patient-to-nurse ratio increased from a prepandemic baseline of 1:1 to 2.4:1.…”

Impact of institutional case volume on intensive care unit mortality

“…A recent US study on intensivist-to-patient ratios examined the outcomes of 51,656 patients under the care of 246 intensivists. The average caseload was 11.8 patients per day, with no evident association between the intensivist-to-patient ratio and mortality (hazard ratio for each additional patient: 0.987; 95% CI, 0.97–1.01; P=0.2) [ 44 ]. In Korea, the average caseload per intensivist was 44.7 patients per day in 2014, which steadily decreased to 22.2 patients per day in 2021 [ 1 ].…”