Abstract
Introduction: There is an increasing interest in ICU attending physician’s workload and its effects not only on patient outcomes but also on trainee education, staff and family satisfaction. Some models attempted to optimize attending physician’s day and night availability to improve patient’s care without increasing the cost. The goal of this project is to identify peak periods where ICU interventions are occurring which might benefit from direct supervision by attending physician. Methods: This is a retrospective, observational study utilizing a single tertiary academic center (34-bed, open, multi-specialty) pediatric intensive care unit (PICU) data submitted to the Virtual PICU system (VPS). All admissions between January 1, 2013 and June 30, 2013 were included. A unit of work was defined as an admission, endotracheal intubation, initiation of mechanical ventilation, central venous line placement, or arterial line placement. The mean number of units of work was determined per day of the week and by 4-hr periods during the day. The work of daily rounds, family meetings and other non-clinical academic meetings were not factored into the analysis. Results: For the first 6 months of 2013, there were 1,188 admissions, 169 central venous line placements, 123 arterial line placements, 113 endotracheal intubations, and 416 mechanical ventilation initiations. The average units of worked peaked on Thursday and Friday at ~14 units/day with a low of ~8 units/day on Saturday and Sunday. While not including the work of rounding and non-clinical duties, on average the busiest times of the day were between 1000 to 1400 and 1400 to 1800 with ~2.3 units/4-hr period in each block. The work slowed to only 1 unit/4-hr period from 0200 to 0600. The peak admission time was from 1400 to 1800 with an average of 1.6 admissions/4-hr period. Conclusions: This study identifies our PICU daily and weekly workload cyclical patterns. In future, this analysis may be useful in determining the appropriate physician staffing models at institutional level.
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