Dustin Hansen, MD
Staff Physician
Sanford Health
Fargo, North Dakota
Disclosure information not submitted.
Amanda Levin, MD
Assistant Professor
Johns Hopkins University, United States
Disclosure information not submitted.
Jim Fackler, MD
Associate Professor, Anesthesiology and Critical Care
Johns Hopkins University, United States
Disclosure information not submitted.
Michael Rosen, PhD
Associate Professor
Johns Hopkins University School of Medicine, United States
Disclosure information not submitted.
Salar Khaleghzadegan, MPP
Senior Research Program Coordinator
Johns Hopkins Armstrong Institute for Patient Safety and Quality, United States
Disclosure information not submitted.
Gayane Yenokyan, PhD
Associate Scientist
Johns Hopkins School of Public Health, United States
Disclosure information not submitted.
David Stockwell, MBA, MD
Associate Professor
Johns Hopkins Hospital, United States
Disclosure information not submitted.
Title: Contributors to Perceived Workload Strain in the Pediatric ICU
INTRODUCTION: Workload strain in intensive care units (ICUs) is of growing interest to physicians and other healthcare providers as some data indicate that patient outcomes are worse when ICUs are strained. ICU strain is often determined by metrics such as overall patient census, number of admissions, and various patient acuity surrogates. To date, little has been reported about possible contributors to strain in the pediatric ICU (PICU). The major aim of this work was to identify factors that contribute to increases in workload strain perceived by physicians and nurses in the PICU.
Methods: Multiple NASA Task Load Index (TLX) and single-item stress scores per PICU shift were collected from physician fellows and senior nurses as markers of perceived workload strain. These data were then compared to various objective patient- and unit-level factors. Visual displays and other exploratory analysis techniques were used to assess the relationships between the possible explanatory variables and the strain measures. Subsequently, linear mixed effect models were used to further characterize the relationships between strain and individual explanatory variables.
Results: Perceived workload strain was higher during day shifts when compared to night shifts and was also higher for physicians than for their nursing colleagues. Metrics related to patient volume, turnover, and acuity as well as reported strain showed significant variation over the course of the data collection period. Patient-level factors associated with increased strain included greater numbers of patients per shift requiring renal replacement therapy and mechanical ventilation/non-invasive positive pressure ventilation. Unit-level factors associated with increased strain included total number of patients admitted and discharged, increased total number of labs drawn, increased total patient hours, and increased total continuous medication infusions.
Conclusions: Several unit- and patient-level factors were found to contribute to increased perceived workload strain in the PICU. These findings provide depth and granularity to the study of workload strain in the PICU and may have implications for improving patient care as this topic is investigated further.