학술논문
SWEAT ICU—An Observational Study of Physician Workload and the Association of Physician Outcomes in Academic ICUs
Document Type
article
Author
Ankita Agarwal, MD, MSc; Jen-Ting Chen, MD, MS; Craig M. Coopersmith, MD, MCCM; Joshua L. Denson, MD, MS; Neal W. Dickert, MD, PhD; Lauren E. Ferrante, MD, MHS; Hayley B. Gershengorn, MD; Adhiraj D. Gosine, MD; Bradley J. Hayward, MD; Navneet Kaur, MD; Akram Khan, MD; Courtney Lamberton, MD; Douglas Landsittel, PhD; Patrick G. Lyons, MD, MSc; Mark E. Mikkelsen, MD, MSCE; Nandita R. Nadig, MD, MSCR; Anthony P. Pietropaoli, MD, MPH; Brian R. Poole, MD; Elizabeth M. Viglianti, MD, MPH, MSc; Jonathan E. Sevransky, MD, MHS; on behalf of SCCM Discovery Network
Source
Critical Care Explorations, Vol 4, Iss 10, p e0774 (2022)
Subject
Language
English
ISSN
2639-8028
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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.