Beyond capacity: an EAST multicenter mixed-methods study exploring surgeon perceptions on patient ratios in acute...

Area of Science:

• Surgery
• Healthcare Management
• Patient Safety

Background:

• Optimal provider-to-patient (PtP) ratios in acute care surgery (ACS) are undefined.
• These ratios are critical for ensuring care quality and provider sustainability.

Purpose of the Study:

• To determine surgeon perspectives on maximum ideal PtP ratios in ACS.
• To assess these ratios across trauma, emergency general surgery (EGS), and surgical intensive care unit (SICU) services.

Main Methods:

• A multicenter mixed-methods study involving quantitative surveys and semistructured interviews with ACS surgeons.
• Data collected from surgeons at level I/II trauma centers across the USA.
• Surveys and interviews analyzed using descriptive statistics and qualitative analysis, respectively.

Main Results:

• Perceived maximum safe loads: <20 patients independently for trauma/EGS, ≤10 for SICU.
• With team support, loads up to 40 for trauma/EGS and ≤20 for SICU were considered safe.
• 72% of centers exceeded their own leadership-recommended maximums, with acuity and workload impacting ratios.

Conclusions:

• This study establishes potential upper threshold benchmarks for ACS PtP ratios.
• Division leadership should develop staffing models considering acuity and complexity, with escalation protocols for high workloads.
• Current practices often exceed ideal ratios, necessitating evidence-based guidelines to balance finances and patient outcomes.