Contributors to perceived workload strain in the pediatric intensive care unit

Area of Science:

• Critical Care Medicine
• Healthcare Operations
• Occupational Health Psychology

Background:

• Intensive care unit (ICU) capacity strain correlates with poorer patient outcomes.
• Objective metrics like patient census and acuity do not fully capture healthcare worker workload.
• Perceived workload strain is a critical factor in healthcare delivery.

Purpose of the Study:

• To identify factors contributing to perceived workload strain in a pediatric intensive care unit (PICU).
• To utilize the NASA Task Load Index (TLX) and single item stress scores (SISS) to quantify perceived strain.
• To correlate perceived strain with objective patient and unit-level data.

Main Methods:

• Prospective observational study at a single center.
• Collected NASA TLX and SISS data per PICU shift from physician fellows and charge nurses.
• Compared perceived strain data with electronic medical record (EMR) data on patient volume, turnover, acuity, and unit operations.
• Employed visual techniques and linear mixed-effect models for analysis.

Main Results:

• Perceived workload strain was higher during day shifts compared to night shifts.
• Physicians reported higher strain than nurses.
• Increased strain was associated with patients requiring renal replacement therapy or mechanical ventilation.
• Higher patient admission/discharge rates, blood draws, patient hours, and continuous infusions correlated with increased strain.

Conclusions:

• The PICU environment presents dynamic demands that can exceed healthcare worker thresholds for strain.
• Findings offer granular insights into PICU workload strain.
• This research has implications for optimizing PICU operations and enhancing patient care quality.