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：
10611850
负责人：
Hayley Beth Gershengorn
金额：
$ 33.42万
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/10611850
关键词：
Acute Acute Respiratory Distress Syndrome Acute respiratory failure Address Administrator Admission activity Adult Affect Age Distribution American Beds California Caring Case Mixes Censuses Certification Clinical Pharmacists Complex Country Coupled Critical Care Critical Illness Data Dedications 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 Recommendation Resources Respondent Sampling Services Severities Severity of illness Societies Structure Surveys System Training United Kingdom United States Update Work Workload aging population asthma exacerbation care coordination care delivery care providers clinical database cohort dynamic system 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结构和组织的影响。大约有600万美国人被录取每年进行重症监护病房（ICU），许多人需要机械通气以使急性呼吸衰竭。了解最佳的ICU组织对于确保将高质量护理提供给我们至关重要最恶心的患者。在过去的20年中，作为我们的ICU床的数量和提供的护理与之合作的强化主义者（专门接受重症监护培训的医生专业专业的ICU团队（包括护士，呼吸治疗师，临床药剂师等）已成为许多ICU中的规范。研究强调了对重症患病的严格护理的积极影响患者;因此，重症监护医学协会建议“高强度强化主义人员配备”。同样，跨学科团队对患者结局的积极影响也得到了很好的确定。不是什么然而，已知的是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。我们最近在英国的工作表明，每个人都在照顾患者及其患者的死亡率；这种关系在美国是否相同以及它如何受到其他ICU护理提供商的影响。最后，自2000年进行具有里程碑意义的研究以来强调了美国强化主义需求和供应之间的差距，很明显，更新的ICU 需要劳动力项目来帮助资源计划；但是，如果这些受到限制，这些会失败 “孤岛”（例如，预测强化主义需求而不考虑其他护理提供者的缓解效果）和对最佳人员配置结构的评价不足可能与当今使用的情况有所不同。在这项研究中，我们将使用与美国多个ICU的现有患者水平数据相关的主要调查和新颖系统动态建模的方法解决3个目标：（1）当前确定的详细人员配备模型在整个美国使用；（2）量化患者对护理提供者比率与患者预后的关联选定的ICU; （3）估计当前和未来的ICU劳动力需求。该项目将产生关键见解进入ICU护理交付的最佳人员配备模型，以及将来必须分配资源才能关闭 ICU护理提供商差距。虽然专注于ICU护理，但该项目将为（1）创建一个可复制的框架根据其他人员的可用性和（2）使用系统，每天患者人口普查的提供者工作量量化工作量动态建模以模拟劳动力供应和需求，这对于计划的任何方面都是有用的卫生保健。我们将为临床医生和政策制定者提供有关ICU人员配备的关键信息，以改善患者安全。