SWEAT ICU – Study of Workload and the Association of Outcomes in the Intensive Care Unit Público
Agarwal, Ankita (Spring 2022)
Abstract
Introduction: The optimal staffing model for physicians in the intensive care unit (ICU) is unknown. Patient-to-intensivist ratio may offer a simple measure of workload and be associated with an impact on patient and physician outcomes. The aim of this study was to evaluate the association of physician workload as measured by patient-to-intensivist ratio with burnout syndrome (BOS) and patient mortality in the ICU.
Methods: We conducted a cross-sectional observational study across 14 academic centers in the United States from August 2020 to July 2021. We enrolled ICU physicians and adult ICU patients under the participating physician’s care on a single physician-selected study day. The primary exposure was workload, which was defined as the patient-to-intensivist ratio and measured by the number of patients the physician was taking care of on the study day. Workload was modeled as high ( >14 patients per physician) or low (≤14 patients per physician). The primary outcome was BOS as measured by the Well-Being Index. A secondary outcome was 28-day patient mortality. We calculated odds ratios for BOS and patient death using a multivariable logistic regression model and a binomial mixed effects model, respectively.
Results: We enrolled 122 physicians from 62 ICUs with median workload of 12 patients per physician (IQR 10-14) on the study day, and the overall prevalence of BOS was 26.4% (n=32). There was a non-significant decrease in odds of BOS in physicians with high workload versus low when adjusted for patient illness severity factors, ICU team size, ICU strain, and number of new patients (adjusted odds ratio 0.74, 95% CI 0.24 – 2.23). Of 1,322 patients, 679 (51.4%) were discharged alive from the hospital, 257 (19.4%) remained hospitalized, 347 were deceased (26.2%) by day 28; with unknown 28-day outcome for 39 (3.0%) of patients. There was no significant difference in odds of death for patients cared for by physicians with high workload group versus low workload (adjusted odds ratio 1.33, 95% CI 0.92 – 1.91).
Conclusions: In our cohort, approximately 1 in 4 physicians experienced BOS on a single day. There was no relationship between 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.
Table of Contents
A. Introduction 1
B. Background 3
C. Methods 6
D. Results 12
E. Discussion/Conclusion 17
F. References 21
G. Tables/Figures 28
Table 1: Full Physician Workload Survey 28
Table 2: The Well-Being Index 28
Table 3: Full ICU Structure/Summary Survey 29
Table 4: Sequential Organ Failure Assessment (SOFA) Score 30
Table 5: Full Patient Survey 30
Table 6: Enrollment Summary by Site 31
Table 7: Physician Characteristics by Workload Category 32
Table 8: ICU Characteristics by Physician Workload 34
Table 9: Patient Characteristics for Full Patient Cohort 36
Table 10: Logistic Regression for Presence of Burnout Syndrome 38
Table 11: Interaction Analysis with Risk of Burnout Syndrome Stratified by Physician Characteristics 39
Table 12: Logistic Regression for 28-day Patient Mortality 40
Table 13: Sensitivity Analysis for alternative definitions of workload and odds of burnout syndrome 41
Figure 1: Directed Acyclic Graph for Association of Workload and Burnout 42
Figure 2: Directed Acyclic Graph for Association of Workload and Patient Outcomes 43
Figure 3: Box-Whisker Plot of Patients per Physician by Study Site 44
Figure 4: Histogram of Well-Being Index Score Frequencies 45
Figure 5: Presence of ICU strain by Burnout Syndrome Presence 46
Figure 6: Distribution of Median SOFA Score by Burnout Syndrome 47
Figure 7: Forest Plot of odds ratios for burnout syndrome (BOS) by workload models 48
Figure 8: Scatter Plots of Principal Components 49
About this Master's Thesis
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