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Interprofessional Staffing in Pediatric Critical Care: Secondary Analysis of a National Cross-Sectional Survey From
Elizabeth G Broden Arciprete1, Rebecca L Ford2, Shelby L Blalock3
1Department of General Internal Medicine, Department of Health Policy and Management, Yale University, New Haven, CT.
Insights
Pediatric critical care units have intensivists, advanced practice providers, nurses, and respiratory therapists. Staffing levels for intensivists, APPs, and RTs vary by pediatric intensive care unit (PICU) level.
Area of Science:
- Pediatric critical care medicine
- Healthcare staffing and workforce analysis
- Interprofessional healthcare teams
Background:
- The 2019 American Academy of Pediatrics guidelines recommend specific interprofessional staffing for pediatric intensive care units (PICUs) and pediatric cardiac intensive care units (PCICUs).
- Understanding current staffing practices is crucial for ensuring optimal care for critically ill children.
Purpose of the Study:
- To examine the interprofessional staffing models in U.S. pediatric critical care units in 2022-2023.
- To compare staffing between tertiary and quaternary level PICUs/PCICUs.
Main Methods:
- A secondary analysis was conducted using data from a national survey of ICUs (2022-2023) merged with the 2019 American Hospital Association database.
- The study focused on U.S. tertiary and quaternary PICUs/PCICUs.
- Staffing data for intensivists, advanced practice providers (APPs), trainees, nurses, respiratory therapists (RTs), and pharmacists were analyzed.
Main Results:
- Pediatric intensivists were present in 48 of 49 units, with 24-hour onsite coverage in 37 units.
- APPs, fellows, and residents were available in a majority of units.
- Nurse-to-patient ratios varied, with 1:1 for ventilated patients in 21 units and 1:2 in 26 units; 1:2 was most common for noninvasive ventilation.
- Respiratory therapists were available on all shifts in 48 units.
- Pharmacist participation varied by shift, with full-time weekday coverage in 44 units.
- Quaternary units demonstrated significantly higher staffing of 24-hour intensivists, APPs, fellows, residents, and RTs compared to tertiary units (p < 0.05).
Conclusions:
- Pediatric intensivists, APPs, registered nurses, pharmacists, and RTs are available in U.S. pediatric critical care units.
- Staffing levels, particularly for intensivists, APPs, and RTs, differ based on the level of the pediatric intensive care unit (PICU).
Objectives:
The 2019 American Academy of Pediatrics recommendations for PICU and pediatric cardiac ICU (PCICUs) staffing are that it include intensivists, advanced practice providers (APPs), medical trainees, nurses, respiratory therapists (RTs), and pharmacy consultation. We have examined interprofessional staffing in U.S. pediatric critical care units in 2022-2023.
Design:
Secondary analysis of 2022-2023 data from a national survey of ICUs merged with the 2019 American Hospital Association database. We compared tertiary and quaternary unit staffing.
Setting:
U.S. tertiary and quaternary PICUs/PCICUs in 2022-2023.
Patients:
Pediatric patients.
Interventions:
None.
Measurements And Main Results:
We included 49 PICUs/PCICUs (11 tertiary, 38 quaternary) across 26 states: 19 of 49 were in children's hospitals, all were teaching hospitals, and 24 of 49 were considered "large" (16-30 beds). Intensivists were available in 48 of 49 units: onsite 24-hr/d in 37 of 49, worked 7 consecutive days in 32 of 49, and had no other clinical responsibilities during pediatric critical care service in 36 of 49. APPs (31/49), fellows (38/49), and residents (44/49) were available in many units. Nurses were assigned to care for one patient receiving mechanical ventilation in 21 of 49 units or two patients in 26 of 49 units. For noninvasive mechanical ventilation, a ratio of one nurse to two patients was most common (45/49). In 48 of 49 units RTs were available on all shifts. Pharmacists participated in care during weekday shifts in 44 of 49 units. Pharmacists participated in care on weeknights in 18 of 49 units, on weekend days in 29 of 49 units, and on weekend nights in 16 of 49 units. Compared with tertiary units, quaternary unit practice was associated with having more of the following: 24-hour intensivist coverage, APPs, fellows, and residents, RTs throughout all shifts, and more RTs without responsibilities outside the ICU throughout all shifts ( p < 0.05 for all).
Conclusions:
In this 2022-2023 national sample, pediatric intensivists, APPs, registered nurses, pharmacists, and RTs were available to care for critically ill children. Intensivist, APP, and RT staffing varied by PICU level.
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