SWEAT ICU - An Observational Study of Physician Workload and the Association of Physician Outcomes in Academic ICUs

SCCM Discovery Network

doi:10.1097/CCE.0000000000000774

SWEAT ICU - An Observational Study of Physician Workload and the Association of Physician Outcomes in Academic ICUs

SCCM Discovery Network

Medicine, Pulmonary Division

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

OBJECTIVES: The optimal staffing model for physicians in the ICU is unknown. Patient-to-intensivist ratios may offer a simple measure of workload and be associated with patient mortality and physician burnout. To evaluate the association of physician workload, as measured by the patient-to-intensivist ratio, with physician burnout and patient mortality. DESIGN: Cross-sectional observational study. SETTING: Fourteen academic centers in the United States from August 2020 to July 2021. SUBJECTS: We enrolled ICU physicians and collected data on adult ICU patients under the physician's care on the single physician-selected study day for each physician. MEASUREMENTS and MAIN RESULTS: The primary exposure was workload (self-reported number of patients' physician was responsible for) modeled as high (>14 patients) and low (≤14 patients). The primary outcome was burnout, measured by the Well-Being Index. The secondary outcome measure was 28-day patient mortality. We calculated odds ratio for burnout and patient outcomes using a multivariable logistic regression model and a binomial mixed effects model, respectively. We enrolled 122 physicians from 62 ICUs. The median patient-to-intensivist ratio was 12 (interquartile range, 10-14), and the overall prevalence of burnout was 26.4% (n = 32). Intensivist workload was not independently associated with burnout (adjusted odds ratio, 0.74; 95% CI, 0.24-2.23). Of 1,322 patients, 679 (52%) were discharged alive from the hospital, 257 (19%) remained hospitalized, and 347 (26%) were deceased by day 28; 28-day outcomes were unknown for 39 of patients (3%). Intensivist workload was not independently associated with 28-day patient mortality (adjusted odds ratio, 1.33; 95% CI, 0.92-1.91). CONCLUSIONS: In our cohort, approximately one in four physicians experienced burnout on the study day. There was no relationship be- tween workload as measured by patient-to-intensivist ratio and burnout. Factors other than the number of patients may be important drivers of burnout among ICU physicians.

Original language	English (US)
Pages (from-to)	E0774
Journal	Critical Care Explorations
Volume	4
Issue number	10
DOIs	https://doi.org/10.1097/CCE.0000000000000774
State	Published - Oct 13 2022

Funding

Supported, in part, by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002378. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Agarwal reports funding from National Institute of General Medical Sciences T32 Training Grant (T32GM095442, principal investigator: C. M. Coopersmith). Dr. Dickert reports funding from the National Institutes of Health and Agency for Healthcare Research and Quality, and for consulting for Abiomed. Dr. Sevransky reports funding to institution from the Marcus foundation, Department of Defense, Center for Diseases Control Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Keywords

burnout
intensive care unit
mortality
patient-to-intensivist ratio
workforce
workload

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

Access to Document

10.1097/CCE.0000000000000774

Cite this

@article{af08197409694a26b408b6e2316e1d24,

title = "SWEAT ICU - An Observational Study of Physician Workload and the Association of Physician Outcomes in Academic ICUs",

abstract = "OBJECTIVES: The optimal staffing model for physicians in the ICU is unknown. Patient-to-intensivist ratios may offer a simple measure of workload and be associated with patient mortality and physician burnout. To evaluate the association of physician workload, as measured by the patient-to-intensivist ratio, with physician burnout and patient mortality. DESIGN: Cross-sectional observational study. SETTING: Fourteen academic centers in the United States from August 2020 to July 2021. SUBJECTS: We enrolled ICU physicians and collected data on adult ICU patients under the physician's care on the single physician-selected study day for each physician. MEASUREMENTS and MAIN RESULTS: The primary exposure was workload (self-reported number of patients' physician was responsible for) modeled as high (>14 patients) and low (≤14 patients). The primary outcome was burnout, measured by the Well-Being Index. The secondary outcome measure was 28-day patient mortality. We calculated odds ratio for burnout and patient outcomes using a multivariable logistic regression model and a binomial mixed effects model, respectively. We enrolled 122 physicians from 62 ICUs. The median patient-to-intensivist ratio was 12 (interquartile range, 10-14), and the overall prevalence of burnout was 26.4% (n = 32). Intensivist workload was not independently associated with burnout (adjusted odds ratio, 0.74; 95% CI, 0.24-2.23). Of 1,322 patients, 679 (52%) were discharged alive from the hospital, 257 (19%) remained hospitalized, and 347 (26%) were deceased by day 28; 28-day outcomes were unknown for 39 of patients (3%). Intensivist workload was not independently associated with 28-day patient mortality (adjusted odds ratio, 1.33; 95% CI, 0.92-1.91). CONCLUSIONS: In our cohort, approximately one in four physicians experienced burnout on the study day. There was no relationship be- tween workload as measured by patient-to-intensivist ratio and burnout. Factors other than the number of patients may be important drivers of burnout among ICU physicians.",

keywords = "burnout, intensive care unit, mortality, patient-to-intensivist ratio, workforce, workload",

author = "{SCCM Discovery Network} and Ankita Agarwal and Chen, {Jen Ting} and Coopersmith, {Craig M.} and Denson, {Joshua L.} and Dickert, {Neal W.} and Ferrante, {Lauren E.} and Gershengorn, {Hayley B.} and Gosine, {Adhiraj D.} and Hayward, {Bradley J.} and Navneet Kaur and Akram Khan and Courtney Lamberton and Douglas Landsittel and Lyons, {Patrick G.} and Mikkelsen, {Mark E.} and Nadig, {Nandita R.} and Pietropaoli, {Anthony P.} and Poole, {Brian R.} and Viglianti, {Elizabeth M.} and Sevransky, {Jonathan E.}",

note = "Publisher Copyright: {\textcopyright} 2022 The Authors. Published by Wolters Kluwer Health, Inc.",

year = "2022",

month = oct,

day = "13",

doi = "10.1097/CCE.0000000000000774",

language = "English (US)",

volume = "4",

pages = "E0774",

journal = "Critical Care Explorations",

issn = "2639-8028",

publisher = "Lippincott Williams and Wilkins",

number = "10",

}

TY - JOUR

T1 - SWEAT ICU - An Observational Study of Physician Workload and the Association of Physician Outcomes in Academic ICUs

AU - SCCM Discovery Network

AU - Agarwal, Ankita

AU - Chen, Jen Ting

AU - Coopersmith, Craig M.

AU - Denson, Joshua L.

AU - Dickert, Neal W.

AU - Ferrante, Lauren E.

AU - Gershengorn, Hayley B.

AU - Gosine, Adhiraj D.

AU - Hayward, Bradley J.

AU - Kaur, Navneet

AU - Khan, Akram

AU - Lamberton, Courtney

AU - Landsittel, Douglas

AU - Lyons, Patrick G.

AU - Mikkelsen, Mark E.

AU - Nadig, Nandita R.

AU - Pietropaoli, Anthony P.

AU - Poole, Brian R.

AU - Viglianti, Elizabeth M.

AU - Sevransky, Jonathan E.

PY - 2022/10/13

Y1 - 2022/10/13

N2 - OBJECTIVES: The optimal staffing model for physicians in the ICU is unknown. Patient-to-intensivist ratios may offer a simple measure of workload and be associated with patient mortality and physician burnout. To evaluate the association of physician workload, as measured by the patient-to-intensivist ratio, with physician burnout and patient mortality. DESIGN: Cross-sectional observational study. SETTING: Fourteen academic centers in the United States from August 2020 to July 2021. SUBJECTS: We enrolled ICU physicians and collected data on adult ICU patients under the physician's care on the single physician-selected study day for each physician. MEASUREMENTS and MAIN RESULTS: The primary exposure was workload (self-reported number of patients' physician was responsible for) modeled as high (>14 patients) and low (≤14 patients). The primary outcome was burnout, measured by the Well-Being Index. The secondary outcome measure was 28-day patient mortality. We calculated odds ratio for burnout and patient outcomes using a multivariable logistic regression model and a binomial mixed effects model, respectively. We enrolled 122 physicians from 62 ICUs. The median patient-to-intensivist ratio was 12 (interquartile range, 10-14), and the overall prevalence of burnout was 26.4% (n = 32). Intensivist workload was not independently associated with burnout (adjusted odds ratio, 0.74; 95% CI, 0.24-2.23). Of 1,322 patients, 679 (52%) were discharged alive from the hospital, 257 (19%) remained hospitalized, and 347 (26%) were deceased by day 28; 28-day outcomes were unknown for 39 of patients (3%). Intensivist workload was not independently associated with 28-day patient mortality (adjusted odds ratio, 1.33; 95% CI, 0.92-1.91). CONCLUSIONS: In our cohort, approximately one in four physicians experienced burnout on the study day. There was no relationship be- tween workload as measured by patient-to-intensivist ratio and burnout. Factors other than the number of patients may be important drivers of burnout among ICU physicians.

AB - OBJECTIVES: The optimal staffing model for physicians in the ICU is unknown. Patient-to-intensivist ratios may offer a simple measure of workload and be associated with patient mortality and physician burnout. To evaluate the association of physician workload, as measured by the patient-to-intensivist ratio, with physician burnout and patient mortality. DESIGN: Cross-sectional observational study. SETTING: Fourteen academic centers in the United States from August 2020 to July 2021. SUBJECTS: We enrolled ICU physicians and collected data on adult ICU patients under the physician's care on the single physician-selected study day for each physician. MEASUREMENTS and MAIN RESULTS: The primary exposure was workload (self-reported number of patients' physician was responsible for) modeled as high (>14 patients) and low (≤14 patients). The primary outcome was burnout, measured by the Well-Being Index. The secondary outcome measure was 28-day patient mortality. We calculated odds ratio for burnout and patient outcomes using a multivariable logistic regression model and a binomial mixed effects model, respectively. We enrolled 122 physicians from 62 ICUs. The median patient-to-intensivist ratio was 12 (interquartile range, 10-14), and the overall prevalence of burnout was 26.4% (n = 32). Intensivist workload was not independently associated with burnout (adjusted odds ratio, 0.74; 95% CI, 0.24-2.23). Of 1,322 patients, 679 (52%) were discharged alive from the hospital, 257 (19%) remained hospitalized, and 347 (26%) were deceased by day 28; 28-day outcomes were unknown for 39 of patients (3%). Intensivist workload was not independently associated with 28-day patient mortality (adjusted odds ratio, 1.33; 95% CI, 0.92-1.91). CONCLUSIONS: In our cohort, approximately one in four physicians experienced burnout on the study day. There was no relationship be- tween workload as measured by patient-to-intensivist ratio and burnout. Factors other than the number of patients may be important drivers of burnout among ICU physicians.

KW - burnout

KW - intensive care unit

KW - mortality

KW - patient-to-intensivist ratio

KW - workforce

KW - workload

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U2 - 10.1097/CCE.0000000000000774

DO - 10.1097/CCE.0000000000000774

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SN - 2639-8028

VL - 4

SP - E0774

JO - Critical Care Explorations

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IS - 10

ER -

SWEAT ICU - An Observational Study of Physician Workload and the Association of Physician Outcomes in Academic ICUs

Abstract

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Keywords

ASJC Scopus subject areas

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