SWEAT ICU-An Observational Study of Physician Workload and the Association of Physician Outcomes in Academic ICUs

Ankita Agarwal; Jen-Ting Chen; Craig M Coopersmith; Joshua L Denson; Neal W Dickert; Lauren E Ferrante; Hayley B Gershengorn; Adhiraj D Gosine; Bradley J Hayward; Navneet Kaur; Akram Khan; Courtney Lamberton; Douglas Landsittel; Patrick G Lyons; Mark E Mikkelsen; Nandita R Nadig; Anthony P Pietropaoli; Brian R Poole; Elizabeth M Viglianti; Jonathan E Sevransky

doi:10.1097/CCE.0000000000000774

SWEAT ICU-An Observational Study of Physician Workload and the Association of Physician Outcomes in Academic ICUs

Crit Care Explor. 2022 Oct 13;4(10):e0774. doi: 10.1097/CCE.0000000000000774. eCollection 2022 Oct.

Authors

Ankita Agarwal^{1

2}, Jen-Ting Chen³, Craig M Coopersmith^{2

4}, Joshua L Denson⁵, Neal W Dickert^{6

7}, Lauren E Ferrante⁸, Hayley B Gershengorn^{3

9}, Adhiraj D Gosine⁹, Bradley J Hayward¹⁰, Navneet Kaur¹¹, Akram Khan¹², Courtney Lamberton¹³, Douglas Landsittel¹⁴, Patrick G Lyons¹⁵, Mark E Mikkelsen¹⁶, Nandita R Nadig¹⁷, Anthony P Pietropaoli¹⁸, Brian R Poole¹⁹, Elizabeth M Viglianti²⁰, Jonathan E Sevransky^{1

2}

Affiliations

¹ Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
² Emory Critical Care Center, Emory Healthcare, Atlanta, GA.
³ Division of Critical Care Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
⁴ Department of Surgery, Emory University School of Medicine, Atlanta, GA.
⁵ Section of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University School of Medicine, New Orleans, LA.
⁶ Department of Medicine, Emory University School of Medicine, Atlanta, GA.
⁷ Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA.
⁸ Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
⁹ Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL.
¹⁰ Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, NY.
¹¹ Division of Pulmonary and Critical Care Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
¹² Division of Pulmonary Critical Care, Oregon Health and Science University, Portland, OR.
¹³ Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
¹⁴ Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, IN.
¹⁵ Department of Medicine, Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO.
¹⁶ Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO.
¹⁷ Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL.
¹⁸ Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Rochester Medical Center, Rochester, NY.
¹⁹ Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah, Salt Lake City, UT.
²⁰ Division Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI.

Abstract

The optimal staffing model for physicians in the ICU is unknown. Patient-to-intensivist ratios may offer a simple measure of workload and be associated with patient mortality and physician burnout. To evaluate the association of physician workload, as measured by the patient-to-intensivist ratio, with physician burnout and patient mortality.

Design: Cross-sectional observational study.

Setting: Fourteen academic centers in the United States from August 2020 to July 2021.

Subjects: We enrolled ICU physicians and collected data on adult ICU patients under the physician's care on the single physician-selected study day for each physician.

Measurements and main results: The primary exposure was workload (self-reported number of patients' physician was responsible for) modeled as high (>14 patients) and low (≤14 patients). The primary outcome was burnout, measured by the Well-Being Index. The secondary outcome measure was 28-day patient mortality. We calculated odds ratio for burnout and patient outcomes using a multivariable logistic regression model and a binomial mixed effects model, respectively. We enrolled 122 physicians from 62 ICUs. The median patient-to-intensivist ratio was 12 (interquartile range, 10-14), and the overall prevalence of burnout was 26.4% (n = 32). Intensivist workload was not independently associated with burnout (adjusted odds ratio, 0.74; 95% CI, 0.24-2.23). Of 1,322 patients, 679 (52%) were discharged alive from the hospital, 257 (19%) remained hospitalized, and 347 (26%) were deceased by day 28; 28-day outcomes were unknown for 39 of patients (3%). Intensivist workload was not independently associated with 28-day patient mortality (adjusted odds ratio, 1.33; 95% CI, 0.92-1.91).

Conclusions: In our cohort, approximately one in four physicians experienced burnout on the study day. There was no relationship be- tween workload as measured by patient-to-intensivist ratio and burnout. Factors other than the number of patients may be important drivers of burnout among ICU physicians.

Keywords: burnout; intensive care unit; mortality; patient-to-intensivist ratio; workforce; workload.

Abstract

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