Stephen M Pastores1, Vladimir Kvetan, Craig M Coopersmith2, J Christopher Farmer3, Curtis Sessler4, John W Christman5, Rhonda D'Agostino6, Jose Diaz-Gomez7, Sara R Gregg2, Roozehra A Khan8, April N Kapu9, Henry Masur10, Gargi Mehta11, Jason Moore12, John M Oropello13, Kristen Price14. 1. Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY. 2. Department of Surgery, Emory Critical Care Center, Emory University, Atlanta, GA. 3. Department of Critical Care Medicine, Mayo Clinic, Phoenix, AZ. 4. Division of Pulmonary Diseases and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA. 5. Division of Pulmonary, Allergy, Critical Care and Sleep, The Ohio State University Wexner Medical Center, Columbus, OH. 6. Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY. 7. Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL. 8. Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA. 9. Vanderbilt University School of Nursing, Vanderbilt University Medical Center, Nashville, TN. 10. Department of Critical Care Medicine, National Institutes of Health Clinical Center, Bethesda, MD. 11. Jay B. Langner Critical Care System, Montefiore Medical Center, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY. 12. Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA. 13. Division of Critical Care Medicine, Department of Surgery, Mount Sinai Medical Center, New York, NY. 14. Department of Critical Care Medicine, MD Anderson Cancer Center, Houston, TX.
Abstract
OBJECTIVES: To assess-by literature review and expert consensus-workforce, workload, and burnout considerations among intensivists and advanced practice providers. DESIGN: Data were synthesized from monthly expert consensus and literature review. SETTING: Workforce and Workload section workgroup of the Academic Leaders in Critical Care Medicine Task Force. MEASUREMENTS AND MAIN RESULTS: Multidisciplinary care teams led by intensivists are an essential component of critical care delivery. Advanced practice providers (nurse practitioners and physician assistants) are progressively being integrated into ICU practice models. The ever-increasing number of patients with complex, life-threatening diseases, concentration of ICU beds in few centralized hospitals, expansion of specialty ICU services, and desire for 24/7 availability have contributed to growing intensivist staffing concerns. Such staffing challenges may negatively impact practitioner wellness, team perception of care quality, time available for teaching, and length of stay when the patient to intensivist ratio is greater than or equal to 15. Enhanced team communication and reduction of practice variation are important factors for improved patient outcomes. A diverse workforce adds value and enrichment to the overall work environment. Formal succession planning for ICU leaders is crucial to the success of critical care organizations. Implementation of a continuous 24/7 ICU coverage care model in high-acuity, high-volume centers should be based on patient-centered outcomes. High levels of burnout syndrome are common among intensivists. Prospective analyses of interventions to decrease burnout within the ICU setting are limited. However, organizational interventions are felt to be more effective than those directed at individuals. CONCLUSIONS: Critical care workforce and staffing models are myriad and based on several factors including local culture and resources, ICU organization, and strategies to reduce burden on the ICU provider workforce. Prospective studies to assess and avoid the burnout syndrome among intensivists and advanced practice providers are needed.
OBJECTIVES: To assess-by literature review and expert consensus-workforce, workload, and burnout considerations among intensivists and advanced practice providers. DESIGN: Data were synthesized from monthly expert consensus and literature review. SETTING: Workforce and Workload section workgroup of the Academic Leaders in Critical Care Medicine Task Force. MEASUREMENTS AND MAIN RESULTS: Multidisciplinary care teams led by intensivists are an essential component of critical care delivery. Advanced practice providers (nurse practitioners and physician assistants) are progressively being integrated into ICU practice models. The ever-increasing number of patients with complex, life-threatening diseases, concentration of ICU beds in few centralized hospitals, expansion of specialty ICU services, and desire for 24/7 availability have contributed to growing intensivist staffing concerns. Such staffing challenges may negatively impact practitioner wellness, team perception of care quality, time available for teaching, and length of stay when the patient to intensivist ratio is greater than or equal to 15. Enhanced team communication and reduction of practice variation are important factors for improved patient outcomes. A diverse workforce adds value and enrichment to the overall work environment. Formal succession planning for ICU leaders is crucial to the success of critical care organizations. Implementation of a continuous 24/7 ICU coverage care model in high-acuity, high-volume centers should be based on patient-centered outcomes. High levels of burnout syndrome are common among intensivists. Prospective analyses of interventions to decrease burnout within the ICU setting are limited. However, organizational interventions are felt to be more effective than those directed at individuals. CONCLUSIONS: Critical care workforce and staffing models are myriad and based on several factors including local culture and resources, ICU organization, and strategies to reduce burden on the ICU provider workforce. Prospective studies to assess and avoid the burnout syndrome among intensivists and advanced practice providers are needed.
Authors: Krzysztof Laudanski; Ann Marie Huffenberger; Michael J Scott; Justin Wain; Danyal Ghani; C William Hanson Journal: BMC Health Serv Res Date: 2022-07-02 Impact factor: 2.908
Authors: Erin Abu-Rish Blakeney; Hebatallah Naim Ali; Nicole Summerside; Danielle C Lavallee; Benjamin Kragen; Mayumi A Willgerodt; Bryan J Weiner; Leah Spacciante; Brenda K Zierler Journal: Health Care Manage Rev Date: 2021 Oct-Dec 01