ICU Staffing in the United States.

BACKGROUND: The last national estimates of US ICU physician staffing are 25 years old and lack information about interprofessional teams. RESEARCH QUESTION: How are US adult ICUs currently staffed? STUDY DESIGN AND METHODS: We conducted a cross-sectional survey (May 4, 2022-February 2, 2023) of adult ICU physicians (targeting nurse/physician leadership) contacted using 2020 American Hospital Association (AHA) database information and, secondarily, through professional organizations. The survey included questions about interprofessional ICU staffing availability and roles at steady state (pre-COVID-19). We linked survey data to hospital data in the AHA database to create weighted national estimates by extrapolating ICU staffing data to nonrespondent hospitals based on hospital characteristics. RESULTS: The cohort consisted of 596 adult ICUs (response rates: AHA contacts: 2.1%; professional organizations: unknown) with geographic diversity and size variability (median, 20 beds; interquartile range, 12-25); most cared for mixed populations (414 [69.5%]), yet medical (55 [9.2%]), surgical (70 [11.7%]), and specialty (57 [9.6%]) ICUs were well represented. A total of 554 (93.0%) had intensivists available, with intensivists covering all patients in 75.6% of these and onsite 24 h/d in one-half (53.3% weekdays; 51.8% weekends). Of all ICUs, 69.8% had physicians-in-training and 77.7% had nurse practitioners/physician assistants. For patients on mechanical ventilation, nurse to patient ratios were 1:2 in 89.6%. Clinical pharmacists were available in 92.6%, and respiratory therapists were available in 98.8%. We estimated 85.1% (95% CI, 85.7%-84.5%) of hospitals nationally had ICUs with intensivists, 51.6% (95% CI, 50.6%-52.5%) had physicians-in-training, 72.1% (95% CI, 71.3%-72.9%) had nurse practitioners/physician assistants, 98.5% (95% CI, 98.4%-98.7%) had respiratory therapists, and 86.9% (95% CI, 86.4%-87.4%) had clinical pharmacists. For patients on mechanical ventilation, 86.4% (95% CI, 85.8%-87.0%) used 1:2 nurses/patients. INTERPRETATION: Intensivist presence in adult US ICUs has greatly increased over 25 years. Intensivists, respiratory therapists, and clinical pharmacists are commonly available, and each nurse usually provides care for two patients on mechanical ventilation. However, team composition and workload vary.

Severe Burnout Is Common Among Critical Care Physician Assistants.

OBJECTIVES: To determine the prevalence of and risk factors for burnout among critical care medicine physician assistants. DESIGN: Online survey. SETTINGS: U.S. ICUs. SUBJECTS: Critical care medicine physician assistant members of the Society of Critical Care Medicine coupled with personal contacts. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We used SurveyMonkey to query critical care medicine physician assistants on demographics and the full 22-question Maslach Burnout Inventory, a validated tool comprised of three subscales-emotional exhaustion, depersonalization, and achievement. Multivariate regression was performed to identify factors independently associated with severe burnout on at least one subscale and higher burnout scores on each subscale and the total inventory. From 431 critical care medicine physician assistants invited, 135 (31.3%) responded to the survey. Severe burnout was seen on at least one subscale in 55.6%-10% showed evidence of severe burnout on the "exhaustion" subscale, 44% on the "depersonalization" subscale, and 26% on the "achievement" subscale. After multivariable adjustment, caring for fewer patients per shift (odds ratio [95% CI]: 0.17 [0.05-0.57] for 1-5 vs 6-10 patients; p = 0.004) and rarely providing futile care (0.26 [0.07-0.95] vs providing futile care often; p = 0.041) were independently associated with having less severe burnout on at least one subscale. Those caring for 1-5 patients per shift and those providing futile care rarely also had a lower depersonalization scores; job satisfaction was independently associated with having less exhaustion, less depersonalization, a greater sense of personal achievement, and a lower overall burnout score. CONCLUSIONS: Severe burnout is common in critical care medicine physician assistants. Higher patient-to-critical care medicine physician assistant ratios and provision of futile care are risk factors for severe burnout.