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Intensive Care Medicine
Published in: Intensive Care Medicine 2/2011

01-02-2011 | Pediatric Original

The relationship between workload and medical staffing levels in a paediatric cardiac intensive care unit

Authors: Katherine L. Brown, Christina Pagel, Alison Pienaar, Martin Utley

Published in: Intensive Care Medicine | Issue 2/2011

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Abstract

Objective

To evaluate the matching between workload in a paediatric cardiac intensive care unit (ICU) and the corresponding medical staffing levels over a 24-h period.

Design

A review of workload measured by: (a) admissions, (b) severity of illness in admissions using case-mix descriptors and mortality as a proxy, (c) cardiac arrests (CA) and (d) extracorporeal membrane oxygenation (ECMO) cannulations. An evaluation of matching between workload and medical staff schedules.

Setting

A tertiary paediatric cardiac ICU.

Patients

2,799 admissions over a 49-month period.

Results

New admissions peaked in the evening, and the ratio of doctors’ hours to admissions was lowest between 1359 and 2000 h. Although only 515 (17.3%) cases were admitted between 2000 and 0759 h, these were more likely to be emergencies, to have higher Paediatric Index of Mortality 2 (PIM2) scores and to die (p < 0.001). There was an increased adjusted risk of death in admissions between 2000 and 0159 h (p = 0.021). There was no difference in the occurrence of either CA (p = 0.41) or ECMO (p = 0.95) between day and night. The ratio of doctors’ hours to CAs and ECMOs was lowest from 2000 to 0800 h. The conventional medical staffing roster generated the greatest concentration of staff in the morning, reducing to the lowest level between 0200 and 0759 h.

Conclusions

Workload was most intense for the in-house team at night, in terms of sicker admissions, ECMOs and cardiac arrests. Conventional roster patterns may not offer ideal matching between staffing and workload. Data analysis of variable and urgent workload may be used to inform medical rosters.
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Metadata
Title
The relationship between workload and medical staffing levels in a paediatric cardiac intensive care unit
Authors
Katherine L. Brown
Christina Pagel
Alison Pienaar
Martin Utley
Publication date
01-02-2011
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 2/2011
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-010-2085-0

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