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Published on: January 16, 2019

Staffing in ICUs: physicians and alternative staffing models.

Allan Garland1, Hayley B Gershengorn2

  • 1Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada.

Chest
|January 2, 2013
PubMed
Summary

Optimal intensive care unit (ICU) physician staffing remains unclear due to inconsistent evidence and study limitations. Future research is crucial to determine the best ICU staffing models for improved patient outcomes.

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Area of Science:

  • Critical Care Medicine
  • Healthcare Management
  • Health Services Research

Background:

  • The optimal physician staffing model for intensive care units (ICUs) is not definitively established.
  • Existing studies on ICU staffing models often have significant limitations and inconsistent findings regarding patient outcomes.
  • Optimal staffing may be influenced by specific ICU characteristics.

Purpose of the Study:

  • To review the current evidence on physician staffing models in ICUs.
  • To identify gaps in knowledge regarding the impact of different staffing strategies on patient outcomes.
  • To highlight the need for further research to inform best practices in ICU physician coverage.

Main Methods:

  • Review of existing literature on ICU physician staffing models.
  • Analysis of data concerning patient outcomes in relation to intensivist involvement and ICU organizational paradigms (e.g., closed vs. open ICUs).
  • Evaluation of the impact of around-the-clock intensivist presence and the role of nonphysician providers.

Main Results:

  • Evidence on the superiority of closed-model ICUs is inconsistent, and the specific contributing factors remain unclear.
  • Studies on 24/7 intensivist coverage have not consistently demonstrated improved patient outcomes.
  • Care provided by teams including nurse practitioners or physician assistants appears safe and comparable to other models.

Conclusions:

  • There is no consensus on the best physician staffing model for ICUs.
  • Challenges such as intensivist shortages and trainee duty hour limitations necessitate innovative staffing solutions.
  • Further multi-site quantitative research is essential to develop a comprehensive understanding of how ICU staffing affects patient outcomes.