Variation in Bed-to-Physician Ratios During Weekday Daytime Hours in ICUs in Australia and New Zealand*. Issue 12 (19th July 2022)

• Record Type: Journal Article
• Authors: Wunsch, Hannah; Pilcher, David V.; Litton, Edward; Anstey, Matthew; Garland, Allan; Gershengorn, Hayley B.
• Is Part Of: Critical care medicine. Volume 50:Issue 12(2022)
• Page Start: 1737
• Page End: 1747
• Publication Date: 2022-07-19
• Subjects: Australia -- critical care medicine -- intensive care unit -- intensivists -- physicians -- staffing; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000005623
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : OBJECTIVES: To determine common "bed-to-physician" ratios during weekday hours across ICUs and assess factors associated with variability in this ratio. DESIGN: Retrospective cohort study. SETTING: All ICUs in Australia/New Zealand that participated in a staffing survey administered in 2017–2018. PATIENTS: ICU admissions from 2016 to 2018. METHODS: We linked survey data with patient-level data. We defined: 1) bed-to-intensivist ratio as the number of usually available ICU beds divided by the number of onsite weekday daytime intensivists; and 2) bed-to-physician ratio as the number of available ICU beds divided by the total number of physicians (intensivists + nonintensivists, including trainees). We calculated the median and interquartile range (IQR) of bed-to-intensivist ratio and bed-to-physician ratios during weekday hours. We assessed variability in each by type of hospital and ICU and by severity of illness of patients, defined by the predicted hospital mortality. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 123 (87.2%) of Australia/New Zealand ICUs that returned staffing surveys, 114 (92.7%) had an intensivist present during weekday daytime hours, and 116 (94.3%) reported at least one nonintensivist physician. The median bed-to-intensivist ratio was 8.0 (IQR, 6.0–11.4), which decreased to a bed-to-physician ratio of 3.0 (IQR, 2.2–4.9). These ratios varied with mean severity of illness of the patients in the unit. The median bed-to-intensivist ratio was highest (13.5) for ICUs with a mean predicted mortality > 2–4%, and the median bed-to-physician ratio was highest (5.7) for ICUs with a mean predicted mortality of > 4–6%. Both ratios decreased and plateaued in ICUs with a mean predicted mortality for patients greater than 8% (median bed-to-intensivist ratio range, 6.8–8.0, and bed-to-physician ratio range of 2.4–2.7). CONCLUSIONS: Weekday bed-to-physician ratios in Australia/New Zealand ICUs are lower than the bed-to-intensivist ratios and have a relatively fixed ratio of less than 3 for units taking care of patients with a higher average severity of illness. These relationships may be different in other countries or healthcare systems.