Optimizing Intensive Care Unit Staffing in the United States

优化美国重症监护病房的人员配置

基本信息

批准号：
10390335
负责人：
Hayley Beth Gershengorn
金额：
$ 34.18万
依托单位：
UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-04-15 至 2026-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10390335
关键词：
Acute Acute Respiratory Distress Syndrome Acute respiratory failure Address Administrator Admission activity Adult Affect Age Distribution American Beds California Caring Censuses Certification Clinical Pharmacists Complex Country Coupled Critical Care Critical Illness Data Destinations Discipline of Nursing Ensure Environment Future Goals Healthcare Hospital Mortality Hospitals Intensive Care Intensive Care Units Knowledge Laws Length of Stay Life Light Link Lung diseases Masks Massachusetts Mechanical ventilation Medicine Methodology Modeling Nurses Online Systems Organization administrative structures Outcome Oxygen Patient Care Patient Care Team Patient-Focused Outcomes Patients Pattern Pharmacists Physicians Policies Policy Maker Population Growth Professional Organizations Provider Public Health Pulmonology Quality of Care Resources Respondent Sampling Services Severities Severity of illness Societies Structure Surveys System Time Training United Kingdom United States Update Work Workload aging population asthma exacerbation care coordination care delivery care providers clinical database cohort evidence base functional status health care quality improved improved outcome individual patient insight member mortality multidisciplinary novel patient safety physical therapist pressure respiratory response ventilation workforce needs

项目摘要

ABSTRACT Healthcare quality is impacted by structure and organization. Approximately 6 million Americans are admitted to an intensive care unit (ICU) yearly and many require mechanical ventilation for acute respiratory failure. Understanding optimal ICU organization is essential to ensure high quality care is delivered to these, our sickest patients. Over the past 20 years as the number of US ICU beds and the complexity of care provided has increased dramatically, intensivists (physicians trained specifically in critical care) working with interprofessional ICU teams (including nurses, respiratory therapists, clinical pharmacists, etc.) have become the norm in many ICUs. Studies highlight the positive impact of having an intensivist care for critically ill patients; for this reason, the Society of Critical Care Medicine recommends “high intensity intensivist staffing”. Similarly, the positive impact of a multidisciplinary team on patient outcomes is well established. What is not known, however, is how ICU care providers impact patient care in the context of team structure and workload. Our recent work in the United Kingdom suggests there is a significant relationship between the number of patients each intensivist cares for and their patients’ mortality; whether this relationship is the same in the US and how it is affected by other ICU care providers is unknown. Finally, since a landmark study in 2000 highlighted the gap between intensivist demand and supply in the US, it has become clear that updated ICU workforce projections are needed to aid in resource planning; however, these will fail if they are limited by “siloing” (e.g., projecting intensivist need without considering the mitigating effect of other care providers) and an underappreciation of how optimal staffing structures may differ from what is in use today. In this study we will use primary surveys linked with existing patient- level data across multiple US ICUs and a novel methodology of System Dynamics Modeling to address 3 aims: (1) determine detailed staffing models currently used across the US; (2) quantify the association of patient-to-care provider ratio with patient outcomes across selected ICUs; and (3) estimate current and future ICU workforce need. This project will yield critical insights into the best staffing models for ICU care delivery and how resources must be allocated in the future to close ICU care provider gaps. While focused on ICU care, this project will create a replicable framework for (1) quantifying provider workload by daily patient census in light of other staffing availability and (2) using System Dynamics Modeling to simulate workforce supply and demand which will be useful to plan for any aspect of healthcare. We will provide clinicians and policy makers with key information on ICU staffing to improve patient safety.

抽象的医疗保健质量受到结构和组织的影响。大约有 600 万美国人入院。每年都会去重症监护室 (ICU)，许多人因急性呼吸衰竭而需要机械通气。了解最佳的 ICU 组织对于确保为我们的患者提供高质量的护理至关重要过去 20 年来，随着美国 ICU 床位的数量和所提供的护理的复杂性，病情最严重的患者。急剧增加，重症监护医师（专门接受过重症监护培训的医生）与跨专业ICU团队（包括护士、呼吸治疗师、临床药师等）已成为许多 ICU 的常态研究强调了重症监护对重症患者的积极影响。因此，重症监护医学会建议“高强度重症监护人员配置”。同样，多学科团队对患者治疗效果的积极影响也是众所周知的。然而，众所周知的是 ICU 护理提供者如何在团队结构和工作量的背景下影响患者护理。我们最近在英国的研究表明，数量之间存在着显着的关系。每位重症医生所护理的患者及其患者的死亡率在美国是否相同；最后，自 2000 年一项具有里程碑意义的研究以来，它如何受到其他 ICU 护理提供者的影响尚不清楚。强调了美国重症监护室的需求和供应之间的差距，很明显，更新的 ICU 需要进行劳动力预测来帮助进行资源规划；但是，如果受到以下因素的限制，这些预测就会失败； “孤岛”（例如，在不考虑其他护理提供者的缓解效果的情况下预测重症监护的需求）和在这项研究中，我们低估了最佳的人员配置结构可能与当今使用的结构有何不同。将使用与美国多个 ICU 现有患者水平数据相关的初步调查和一项新颖的调查系统动力学建模方法论旨在实现 3 个目标：(1) 确定当前详细的人员配置模型在美国各地使用；（2）量化患者与护理提供者的比率与患者结果之间的关系选定的 ICU；(3) 估计当前和未来的 ICU 劳动力需求该项目将产生重要的见解。探讨 ICU 护理服务的最佳人员配置模式以及未来必须如何分配资源才能关闭 ICU 护理提供者的差距在专注于 ICU 护理的同时，该项目将为 (1) 创建一个可复制的框架。根据其他人员配备情况，通过每日患者普查来量化提供者的工作量，以及 (2) 使用系统动态建模可模拟劳动力的供给和需求，这对于规划劳动力的任何方面都非常有用我们将为民众和政策制定者提供有关 ICU 人员配置的关键信息，以改善患者的状况。安全。