Intensive Care Unit Staffing in the United States.

BACKGROUND: The last national estimates of US intensive care unit (ICU) physician staffing are 25 years old and lack information about interprofessional teams.

RESEARCH QUESTION: How are US adult ICUs currently staffed?

STUDY DESIGN AND METHODS: We conducted a cross-sectional survey (05/04/2022-02/02/2023) of adult ICU clinicians (targeting nurse/physician leadership) contacted using 2020 American Hospital Association (AHA) database information and, secondarily, through professional organizations. The survey included questions about interprofessional ICU staffing availability and roles at steady-state (pre-COVID-19). We linked survey data to hospital data in the AHA database to create weighted national estimates by extrapolating ICU staffing data to non-respondent hospitals based on hospital characteristics.

RESULTS: The cohort consisted of 596 adult ICUs (response rates-AHA contacts: 2.1%; professional organizations: unknown) with geographic diversity and size variability (median [interquartile range]: 20 [12,25] beds); most cared for mixed populations (414 [69.5%]), yet medical (55 [9.2%]), surgical (70 [11.7%]), and specialty (57 [9.6%]) ICUs were well represented. 554 (93.0%) had intensivists available, with intensivists covering all patients in 75.6% of these and onsite 24 hours/day in half (53.3% weekdays; 51.8% weekends). Of all ICUs, 69.8% had physicians-in-training and 77.7% nurse practitioners/physician assistants. For mechanically ventilated patients, nurse:patient ratios were 1:2 in 89.6%. Clinical pharmacists were available in 92.6%, and respiratory therapists in 98.8%. We estimated 85.1% (95% confidence interval: 85.7%, 84.5%) of hospitals nationally had ICUs with intensivists, 51.6% (50.6%, 52.5%) with physicians-in-training, 72.1% (71.3%, 72.9%) with nurse practitioners/physician assistants, 98.5% (98.4%, 98.7%) with respiratory therapists, and 86.9% (86.4%, 87.4%) with clinical pharmacists. For mechanically ventilated patients, 86.4% (85.8%, 87.0%) used 1:2 nurses:patients.

INTERPRETATION: Intensivist presence in adult US ICUs has greatly increased over 25 years. Intensivists, respiratory therapists, and clinical pharmacists are commonly available, and each nurse usually provides care for two mechanically ventilated patients. However, team composition and workload vary.