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Intensivist/Patient Ratios in Closed ICUs: A Statement From the Society of Critical Care Medicine Taskforce on ICU Staffing

Ward, Nicholas S. MD, FCCM1; Afessa, Bekele MD2; Kleinpell, Ruth PhD, RN, FCCM3; Tisherman, Samuel MD, FCCM4; Ries, Michael MD, FCCM5; Howell, Michael MD, MPH6; Halpern, Neil MD, FCCM7; Kahn, Jeremy MD, MS8

doi: 10.1097/CCM.0b013e3182741478
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Objectives: Increases in the number, size, and occupancy rates of ICUs have not been accompanied by a commensurate growth in the number of critical care physicians leading to a workforce shortage. Due to concern that understaffing may exist, the Society of Critical Care Medicine created a taskforce to generate guidelines on maximum intensivists/patient ratios.

Data Sources: A multidisciplinary taskforce conducted a review of published literature on intensivist staffing and related topics, a survey of pulmonary/Critical Care physicians, and held an expert roundtable conference.

Data Extraction: A statement was generated and revised by the taskforce members using an iterative consensus process and submitted for review to the leadership council of the Society of Critical Care Medicine. For the purposes of this statement, the taskforce limited its recommendations to ICUs that use a “closed” model where the intensivists control triage and patient care.

Data Synthesis and Conclusions: The taskforce concluded that while advocating a specific maximum number of patients cared for is unrealistic, an approach that uses the following principles is essential: 1) proper staffing impacts patient care; 2) large caseloads should not preclude rounding in a timely fashion; 3) staffing decisions should factor surge capacity and nondirect patient care activities; 4) institutions should regularly reassess their staffing; 5) high staff turnover or decreases in quality-of-care indicators in an ICU may be markers of overload; 6) telemedicine, advanced practice professionals, or nonintensivist medical staff may be useful to alleviate overburdening the intensivist, but should be evaluated using rigorous methods; 7) in teaching institutions, feedback from faculty and trainees should be sought to understand the implications of potential understaffing on medical education; and 8) in academic medical ICUs, there is evidence that intensivist/patient ratios less favorable than 1:14 negatively impact education, staff well-being, and patient care.

1 Rhode Island Hospital Brown/Alpert Medical School, Providence, RI.

2 Mayo Clinic, Rochester, MN.

3 Rush University Medical Center, Rush University College of Nursing, Chicago, IL.

4 Departments of Critical Care Medicine and Surgery, University of Pittsburg Medical Center, Pittsburg, PA.

5 Advocate Healthcare and Rush University Medical Center, Chicago, IL.

6 Division of Pulmonary, Critical Care & Sleep Medicine Beth Israel Deaconess Medical Center Boston, MA.

7 Critical Care Medicine, Memoral Sloan Kettering Cancer Center, New York, NY.

8 Clinical Research, Investigations and Systems Modeling of Acute Illness, Department of Critical Care Medicine, University of Pittsburg School of Medicine, Pittsburgh, PA.

† For full list of members, see Appendix 2.

Dr. Tisherman has submitted a patent for "Emergency Preservation and Resuscitation Method." Dr. Kahn has received grant support from the National Institutes of Health and Health Services Resource Administration, and he has also received travel reimbursements from the American Thoracic Society. The remaining authors have not disclosed any potential conflicts of interest.

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© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins