Simulation of a Novel Schedule for Intensivist Staffing to Improve Continuity of Patient Care and Reduce Physician Burnout

Abstract

Objective Despite widespread adoption of in-house call for ICU attendings, there is a paucity of research on optimal scheduling of intensivists to provide continuous on-site coverage. Overnight call duties have traditionally been added onto 7 days of continuous daytime clinical service. We designed an alternative ICU staffing model to increase continuity of attending physician care for patients while also decreasing interruptions to attendings’ non-clinical weeks. Design Computer-based simulation of a one-year schedule. Setting A simulated ICU divided into 2 daytime teams each covered by a different attending and both covered by 1 overnight on-call attending. Subjects Simulated patients were randomly admitted on different service days to assess continuity of care. Interventions A Shared Service schedule was compared to a standard 7 Days On schedule. For the 7 Days On schedule, an attending covered a team for 7 consecutive days and off-service attendings cross-covered each night. For the Shared Schedule, 4 attendings shared the majority of daytime and nighttime service for 2 teams over 2 weeks, with recovery periods built into the scheduled service time. Measurements and Main Results Continuity of care as measured by the Continuity of Attending Physician Index (CAPI) increased by 9% with the Shared Schedule. Annually, the Shared Service Schedule was predicted to increase free weekends by 3.4 full weekends and 1.3 weekends with either Saturday or Sunday off. Full weeks without clinical obligations increased by 4 weeks. Mean time between clinical obligations increased by 5.8 days. Conclusions A Shared Service schedule is predicted to improve continuity of care while increasing free weekends and continuity of uninterrupted non-clinical weeks for attendings. Computer-based simulation allows assessment of benefits and tradeoffs of the alternative schedule without disturbing existing clinical systems.

Battling Intensivist Burnout

“…Performing straightforward time for task completion studies and quantifying the number of required tasks are new ICU tools to help dissect the relative contribution of workload/work time imbalance from individual worker inefficiency or lack of resiliency. Countermeasures for workload/work time imbalance include incremental onsite staff support, 32 work schedule modification, 33 coverage using telemedicine support, 34 and altering or better supporting workflows to increase efficiency. 30 Physician dissatisfaction and the burnout they attribute to EHR implementation 30,31 have come as an unpleasant surprise to those (eg, administration leaders) who all too readily accepted manufacturers' promises of increased physician efficiency when they funded the EHR purchase.…”

Well-being in the Intensive Care Unit

“…Geva et al, recently described a simulated model of shared service scheduling whereby four ICU attendings shared most of the day and nighttime service for two teams over a two-week period with creative assignments to avoid thirty plus hour shifts. 54 This simulation study found more continuity of care and less handoffs, making it safer for patients while facilitating improved intensivist work-life balance with more weekends off throughout the year. Further implementation data on this simulation paradigm is awaited.…”

Shared Decision-Making in Acute Pain Services

“…Finally, similarly to time and cost restraints, staff is a limited resource in current times [ 80 - 82 ]. The use of novel staffing models and involvement of acute pain physicians from remote might be a feasible solution to provide specialized care at any time and to any place [ 83 - 85 ]. Such an approach may extend the reach of APS and enable SDM for people with limited access to healthcare.…”