Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.
Department of Surgery, Emory Critical Care Center, Emory University, Atlanta, GA.
Crit Care Med. 2019 Apr;47(4):550-557. doi: 10.1097/CCM.0000000000003637.
To assess-by literature review and expert consensus-workforce, workload, and burnout considerations among intensivists and advanced practice providers.
Data were synthesized from monthly expert consensus and literature review.
Workforce and Workload section workgroup of the Academic Leaders in Critical Care Medicine Task Force.
Multidisciplinary care teams led by intensivists are an essential component of critical care delivery. Advanced practice providers (nurse practitioners and physician assistants) are progressively being integrated into ICU practice models. The ever-increasing number of patients with complex, life-threatening diseases, concentration of ICU beds in few centralized hospitals, expansion of specialty ICU services, and desire for 24/7 availability have contributed to growing intensivist staffing concerns. Such staffing challenges may negatively impact practitioner wellness, team perception of care quality, time available for teaching, and length of stay when the patient to intensivist ratio is greater than or equal to 15. Enhanced team communication and reduction of practice variation are important factors for improved patient outcomes. A diverse workforce adds value and enrichment to the overall work environment. Formal succession planning for ICU leaders is crucial to the success of critical care organizations. Implementation of a continuous 24/7 ICU coverage care model in high-acuity, high-volume centers should be based on patient-centered outcomes. High levels of burnout syndrome are common among intensivists. Prospective analyses of interventions to decrease burnout within the ICU setting are limited. However, organizational interventions are felt to be more effective than those directed at individuals.
Critical care workforce and staffing models are myriad and based on several factors including local culture and resources, ICU organization, and strategies to reduce burden on the ICU provider workforce. Prospective studies to assess and avoid the burnout syndrome among intensivists and advanced practice providers are needed.
通过文献回顾和专家共识，评估重症监护医师和高级实践提供者的劳动力、工作量和倦怠考虑因素。
数据来自每月的专家共识和文献回顾。
重症监护医学学术领袖工作组的劳动力和工作量部分工作组。
由重症监护医师领导的多学科护理团队是重症监护提供的重要组成部分。高级实践提供者（执业护士和医师助理）逐渐被整合到 ICU 实践模式中。患有复杂、危及生命疾病的患者数量不断增加，ICU 床位集中在少数几家医院，专业 ICU 服务的扩展，以及 24/7 可用性的需求，这些都导致了重症监护人员配备的担忧。这种人员配备挑战可能会对从业者的健康、团队对护理质量的看法、教学时间以及当患者与重症监护医师的比例大于或等于 15 时的住院时间产生负面影响。增强团队沟通和减少实践差异是改善患者预后的重要因素。多元化的劳动力为整体工作环境增添了价值和丰富性。为 ICU 领导者制定正式的继任计划对于重症监护组织的成功至关重要。在高容量、高容量中心实施连续 24/7 ICU 覆盖护理模式应基于以患者为中心的结果。在重症监护环境中，倦怠综合征在重症监护医师中很常见。对减少 ICU 环境中倦怠的干预措施进行前瞻性分析的研究有限。然而，人们认为组织干预比针对个人的干预更有效。
重症监护劳动力和人员配备模式多种多样，基于多种因素，包括当地文化和资源、ICU 组织以及减轻 ICU 提供者劳动力负担的策略。需要进行前瞻性研究来评估和避免重症监护医师和高级实践提供者的倦怠综合征。
