30 Jan What Is Right Ratio of Patients to Critical Care Specialists in ICUs?
MedicalResearch.com Interview with:
Dr. Hayley Gershengorn
Dr. Hayley B. Gershengorn, MD
Associate Professor of Clinical Medicine, Department of Medicine (Critical Care)
Assistant Professor, The Saul R. Korey Department of Neurology
Montefiore Medical Center
Bronx, NY
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The patient-to-intensivist ratio across intensive care units is not standardized and whether the patient-to-intensivist ratio impacts patient outcome is not well established. I
n this study, we conducted a retrospective cohort analysis including 49,686 adults across 94 United Kingdom intensive care units. In this setting, a patient-to-intensivist ratio of 7.5 was associated with the lowest risk adjusted hospital mortality, with higher mortality at both higher and lower patient-to-intensivist ratios.
MedicalResearch.com: What should readers take away from your report?
Response: Intensivist staffing should ensure that patient volume is sufficient for proficiency in care, but allows for sufficient time and care to be taken with each patient to minimize harm.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: A limitation of our current study is our ignorance about the non-intensivist staffing of included ICUs. Specifically, we did not have any information about the availability of non-intensivist physicians (e.g., physicians-in-training), nurses, or other providers who comprise the multidisciplinary ICU team. Future study into the association of patient-to-intensivist ratios and patient outcomes would benefit from inclusion of the staffing paradigms for these additional team members as their presence likely affects this association. Additionally, it will be important to investigate the association of patient-to-intensivist ratios and outcomes outside of the United Kingdom as it is unknown whether our results generalize to other settings where casemix and non-intensivist staffing may differ significantly.
MedicalResearch.com: Is there anything else you would like to add?
Response: Our study cannot prove causality, but it is a meaningful step towards understanding the impact of intensivist workload on patient outcomes. The number of ICU beds is increasing in the U.S. and other parts of the world and this often means intensivists are asked to provide care to more and more critically ill patients simultaneously. As a critical care community, we must be mindful of the impact these changes may have on the quality of care we can deliver to our patients.
None of the authors have any disclosures to report. We are thankful to the Intensive Care National Audit & Research Centre (ICNARC) and all the staff in the critical care units participating in the Case Mix Programme. The views and opinions expressed herein and in our manuscript are those of the authors and do not necessarily reflect those of ICNARC.
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Last Updated on January 30, 2017 by Marie Benz MD FAAD