Intensivist staffing and outcome in the ICU

Nizamuddin, Junaid; Tung, Avery

doi:10.1097/aco.0000000000000703

Cited by 8 publications

(7 citation statements)

References 43 publications

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“…Evidence providing guidance for HCW staffing in ICUs and other acute care services under regular (nonpandemic) conditions is abundant and mainly focuses on economics and outcome quality. 5,6 Data in pandemic situations, such as currently with COVID-19, are far more sparse, and only a few authors have suggested that institutions should "allow isolation teams to have a 2-week, off-duty observation period ("washout" period), after every period of ward cover if manpower allows." 7 However, an additional qualified workforce to implement respective policies is typically not available, and optimal HCW staffing strategies remain unclear.…”

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confidence: 99%

Staffing With Disease-Based Epidemiologic Indices May Reduce Shortage of Intensive Care Unit Staff During the COVID-19 Pandemic

Mascha

Schober

Schefold

et al. 2020

Anesthesia &Amp; Analgesia

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Is coronavirus disease 2019 (COVID-19) incubation time-based staffing of benefit with regard to reducing the number of infected health care workers (HCWs)? • Findings: Comprehensive statistical modeling reveals significant reduction of intensive care unit (ICU) staff shortage due to infection when both incubation and quarantine times of CO-VID-19 are considered. • Meaning: Scheduling ICU staff according to the epidemiological characteristics of a pandemic may reduce the number of infected staff and may increase the chances of operational functionality of health care facilities and systems. BACKGROUND: Health care worker (HCW) safety is of pivotal importance during a pandemic such as coronavirus disease 2019 (COVID-19), and employee health and well-being ensure functionality of health care institutions. This is particularly true for an intensive care unit (ICU), where highly specialized staff cannot be readily replaced. In the light of lacking evidence for optimal staffing models in a pandemic, we hypothesized that staff shortage can be reduced when staff scheduling takes the epidemiology of a disease into account. METHODS: Various staffing models were constructed, and comprehensive statistical modeling was performed. A typical routine staffing model was defined that assumed full-time employment (40 h/wk) in a 40-bed ICU with a 2:1 patient-to-staff ratio. A pandemic model assumed that staff worked 12-hour shifts for 7 days every other week. Potential in-hospital staff infections were simulated for a total period of 120 days, with a probability of 10%, 25%, and 40% being infected per week when at work. Simulations included the probability of infection at work for a given week, of fatality after infection, and the quarantine time, if infected. RESULTS: Pandemic-adjusted staffing significantly reduced workforce shortage, and the effect progressively increased as the probability of infection increased. Maximum effects were observed at week 4 for each infection probability with a 17%, 32%, and 38% staffing reduction for an infection probability of 0.10, 0.25, and 0.40, respectively. CONCLUSIONS: Staffing along epidemiologic considerations may reduce HCW shortage by leveling the nadir of affected workforce. Although this requires considerable efforts and commitment of staff, it may be essential in an effort to best maintain staff health and operational functionality of health care facilities and systems.

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confidence: 99%

Staffing With Disease-Based Epidemiologic Indices May Reduce Shortage of Intensive Care Unit Staff During the COVID-19 Pandemic

Mascha

Schober

Schefold

et al. 2020

Anesthesia &Amp; Analgesia

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“…An HIS model, defined as either a mandatory intensivist consultation for all admitted ICU patients or a closed services model in which all care is managed by the intensivist, has been shown to reduce mortality, and improve resource utilization. 3 , 8 , 18 – 20 There are very few studies that compare a mandatory consultation model with a closed-ICU model for delivery of patient care in the ICU. Given the ongoing COVID-19 pandemic, resource utilization has been at the forefront of healthcare discussions.…”

Section: Discussionmentioning

confidence: 99%

The impact of intensive care unit physician staffing change at a community hospital

et al. 2022

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Objectives: A high-intensity staffing model has been defined as either mandatory intensivist consultation or a closed intensive care unit in which intensivists manage all aspects of patient care. In the current climate of limited healthcare resources, transitioning to a closed intensive care unit model may lead to significant improvements in patient care and resource utilization. Methods: This is a single-center, retrospective cohort study of all mechanically ventilated intensive care unit admissions in the pre-intensive care unit closure period of 1 October 2014 to 30 September 2015 as compared with the post-intensive care unit closure period of 1 November 2015 to 31 October 2016. Patient demographics as well as outcome data (duration of mechanical ventilation, length of stay, direct costs, complications, and mortality) were abstracted from the electronic health record. All data were analyzed using descriptive and inferential statistics. Regression analyses were used to adjust outcomes for potential confounders. Results: A total of 549 mechanically ventilated patients were included in our analysis: 285 patients in the pre-closure cohort and 264 patients in the post-closure cohort. After adjusting for confounders, there was no significant difference in mortality rates between the pre-closure (40.7%) and post-closure (38.6%) groups (adjusted odds ratio = 0.82; 95% confidence interval = 0.56–1.18; p = 0.283). The post-closure cohort was found to have significant reductions in duration of mechanical ventilation (3.71–1.50 days; p < 0.01), intensive care unit length of stay (5.8–2.7 days; p < 0.01), hospital length of stay (10.9–7.3 days; p < 0.01), and direct hospital costs (US $16,197–US $12,731; p = 0.009). Patient complications were also significantly reduced post-intensive care unit closure. Conclusion: Although a closed intensive care unit model in our analysis did not lead to a statistical difference in mortality, it did demonstrate multiple beneficial outcomes including reduced ventilator duration, decreased intensive care unit and hospital length of stay, fewer patient complications, and reduced direct hospital costs.

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“…Purported advantages of this model are improved patient care and patient satisfaction, especially when this care model is accompanied by a “system change.” System change involves institution of measures such as liberation from mechanical ventilation, goals of care conversations and other interventions around the clock instead of deferring these “non-emergent” tasks to the day team caring for the patient. 44 , 46 , 53 …”

Section: Introductionmentioning

confidence: 99%

Well-being in the Intensive Care Unit

Cole

Siddiqui

2022

Anesthesiology Clinics

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Synopsis Burnout among critical care personnel has increased due to the additional psychological and physical demands of caring for critically ill patients with limited resources. Factors that increase the risk of burnout include compassion fatigue, lack of control over the work environment, difficult interpersonal relationships, and constant exposure to end-of-life issues. Organizational commitment to physician wellbeing depends on improving workplace efficiency, recognizing stressors at in the critical care environment and providing resources to help manage staffing shortages. Community building, training in communication, and team-building strategies are important steps in building collaboration and camaraderie in the workplace.

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Intensivist staffing and outcome in the ICU

Cited by 8 publications

References 43 publications

Staffing With Disease-Based Epidemiologic Indices May Reduce Shortage of Intensive Care Unit Staff During the COVID-19 Pandemic

Staffing With Disease-Based Epidemiologic Indices May Reduce Shortage of Intensive Care Unit Staff During the COVID-19 Pandemic

The impact of intensive care unit physician staffing change at a community hospital

Well-being in the Intensive Care Unit

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