Interprofessional Staffing Pattern Clusters in U.S. ICUs.

OBJECTIVES

To identify interprofessional staffing pattern clusters used in U.S. ICUs.

DESIGN

Latent class analysis.

SETTING AND PARTICIPANTS

Adult U.S. ICUs.

PATIENTS

None.

INTERVENTIONS

None.

ANALYSIS

We used data from a staffing survey that queried respondents ( = 596 ICUs) on provider (intensivist and nonintensivist), nursing, respiratory therapist, and clinical pharmacist availability and roles. We used latent class analysis to identify clusters describing interprofessional staffing patterns and then compared ICU and hospital characteristics across clusters.

MEASUREMENTS AND MAIN RESULTS

We identified three clusters as optimal. Most ICUs (54.2%) were in cluster 1 ("higher overall staffing") characterized by a higher likelihood of good provider coverage (both intensivist [onsite 24 hr/d] and nonintensivist [orders placed by ICU team exclusively, presence of advanced practice providers, and physicians-in-training]), nursing leadership (presence of charge nurse, nurse educators, and managers), and bedside nursing support (nurses with registered nursing degrees, fewer patients per nurse, and nursing aide availability). One-third (33.7%) were in cluster 2 ("lower intensivist coverage & nursing leadership, higher bedside nursing support") and 12.1% were in cluster 3 ("higher provider coverage & nursing leadership, lower bedside nursing support"). Clinical pharmacists were more common in cluster 1 (99.4%), but present in greater than 85% of all ICUs; respiratory therapists were nearly universal. Cluster 1 ICUs were larger (median 20 beds vs. 15 and 17 in clusters 2 and 3, respectively; < 0.001), and in larger (> 250 beds: 80.6% vs. 66.1% and 48.5%; < 0.001), not-for-profit (75.9% vs. 69.4% and 60.3%; < 0.001) hospitals. Telemedicine use 24 hr/d was more common in cluster 3 units (71.8% vs. 11.7% and 14.1%; < 0.001).

CONCLUSIONS

More than half of U.S. ICUs had higher staffing overall. Others tended to have either higher provider presence and nursing leadership or higher bedside nursing support, but not both.