ICU Staffing in the United States

Area of Science:

• Critical Care Medicine
• Healthcare Management
• Health Services Research

Background:

• National estimates for US intensive care unit (ICU) physician staffing are outdated (25 years) and do not capture interprofessional team dynamics.
• Current ICU staffing models and the roles of various healthcare professionals are not well-characterized.

Purpose of the Study:

• To determine the current staffing composition of adult intensive care units (ICUs) across the United States.
• To assess the availability and roles of interprofessional teams in adult ICUs.

Main Methods:

• A cross-sectional survey was administered to adult ICU clinicians, targeting nurse and physician leadership.
• Data were collected from May 2022 to February 2023, using the American Hospital Association (AHA) database and professional organizations.
• Survey data were linked with AHA database hospital characteristics to generate weighted national estimates.

Main Results:

• The study included 596 adult ICUs, with high availability of intensivists (85.1% nationally), physicians-in-training (51.6%), and advanced practice providers (72.1%).
• Respiratory therapists (98.5%) and clinical pharmacists (86.9%) were widely available.
• For mechanically ventilated patients, nurse-to-patient ratios were 1:2 in 86.4% of ICUs.

Conclusions:

• Intensivist presence in US adult ICUs has significantly increased over the past 25 years.
• Key interprofessional team members, including intensivists, respiratory therapists, and clinical pharmacists, are commonly available.
• While nurse staffing ratios for ventilated patients are often 1:2, overall team composition and workload exhibit variability.