Integrated Critical Care Staffing Model Utilizing Advanced Practice Clinician's and Physicians

Problem: Intensive care units (ICUs) are facing a staffing dilemma as there is a simultaneous increase in elderly patients and a decrease in available intensivists. Two specific consequences stemming from the imbalance of provider and patient ratio include caregiver and compassion burnout. Assessing the need for provider staffing expansion beyond physicians is appropriate in preparing for more critically ill patients and more extended hospital stays. Methods: An urban tertiary hospital ICU staffed solely with physicians is assessed for integrating advance practice clinicians (APCs) into provider coverage. Surveys provided to current intensivists assessed for perceived barriers regarding the use of APCs in the intensive care unit. Caregiver and compassion burnout assessment tools were used to asses for caregiver fatigue. Registered nurses currently working with APCs in the ICU were surveyed to assess for potential benefits in utilizing APCs in the intensive care unit. After proposing the staffing model, the physicians were surveyed again for remaining barriers to implementing APCs into the intensive care unit. Results: The survey results from the registered nurses are positive, focusing on the delineation of care between the physicians and the APC along with ease of asking questions regarding patient care. There was no evidence of caregiver or compassion burnout among the surveyed intensivists. Perceived barriers identified initially were whether the census justified adding APCs, the ability of an APC to care for critically ill patients, and previous experience of working with APCs in the intensive care unit. The follow-up survey results indicated there is a place for APCs in critical care, but the level of training and supervision needed could be an issue. Conclusion: Current intensivists at the urban tertiary hospital are not opposed to APCs working in critical care and feel that the additional staff could ease the patient to provider ratio. However, implementing a staffing model with physicians and APCs is not indicated. The current intensivists report that the patient census is manageable with the eight physicians. Readdressing staffing needs may be appropriate in three to five years as current physicians retire.