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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.
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.
