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Contributors to perceived workload strain in the pediatric intensive care unit
Candace Collins1, Dustin Hansen2, Amanda Levin1
1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD USA.
Insights
Pediatric intensive care unit (PICU) healthcare workers experience higher workload strain during day shifts and with increased patient care demands. Understanding these factors is key to improving patient care and staff well-being.
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.
Objectives:
Patient outcomes worsen during periods of high intensive care units (ICU) capacity strain. Common metrics used to determine workload strain are overall patient census, turnover, and various patient acuity surrogates. We aimed to identify factors that increase perceived workload strain in the pediatric intensive care unit (PICU) using the NASA Task Load Index (TLX) and single item stress scores (SISS).
Methods:
This is a single-center, prospective observational study with survey and electronic medical record (EMR) data. We used multiple NASA TLX and SISS metrics per PICU shift as markers of perceived workload strain. These data, collected from physician fellows and PICU charge nurses, were compared to various objective unit- and patient-level factors. We used exploratory visual techniques as well as linear mixed-effect models to characterize relationships between strain and individual variables. Data was collected during the COVID-19 pandemic between October 2020 and April 2021.
Results:
Workload strain was perceived to be higher during day shifts than night shifts and higher for physicians than nurses. Patient volume, turnover, and acuity metrics as well as reported strain showed significant variation during data collection. Patient-level factors associated with increased strain included more patients per shift requiring renal replacement therapy or mechanical/positive pressure ventilation. Unit-level factors associated with increased strain included increases in the totals of patients admitted and discharged, number of blood draws, patient hours, and continuous medication infusions.
Conclusions:
We find that the PICU is a dynamic environment with variable demands and thresholds beyond which healthcare workers begin to feel increased strain. These findings provide depth and granularity for the study of workload strain in the PICU and could have implications for future improvements in patient care.
Supplementary Information:
The online version contains supplementary material available at 10.1007/s44253-026-00126-4.
