title: Intensivist/patient ratios in closed ICUs: a statement from the Society of Critical Care Medicine Taskforce on ICU Staffing.
abstract: OBJECTIVE
  Increases in the number, size, and occupancy rates of ICUs have not been accompanied by a commensurate growth in the number of critical care physicians leading to a workforce shortage. Due to concern that understaffing may exist, the Society of Critical Care Medicine created a taskforce to generate guidelines on maximum intensivists/patient ratios.
  
  
  METHODS
  A multidisciplinary taskforce conducted a review of published literature on intensivist staffing and related topics, a survey of pulmonary/Critical Care physicians, and held an expert roundtable conference.
  
  
  METHODS
  A statement was generated and revised by the taskforce members using an iterative consensus process and submitted for review to the leadership council of the Society of Critical Care Medicine. For the purposes of this statement, the taskforce limited its recommendations to ICUs that use a "closed" model where the intensivists control triage and patient care.
  
  
  CONCLUSIONS
  The taskforce concluded that while advocating a specific maximum number of patients cared for is unrealistic, an approach that uses the following principles is essential: 1) proper staffing impacts patient care; 2) large caseloads should not preclude rounding in a timely fashion; 3) staffing decisions should factor surge capacity and nondirect patient care activities; 4) institutions should regularly reassess their staffing; 5) high staff turnover or decreases in quality-of-care indicators in an ICU may be markers of overload; 6) telemedicine, advanced practice professionals, or nonintensivist medical staff may be useful to alleviate overburdening the intensivist, but should be evaluated using rigorous methods; 7) in teaching institutions, feedback from faculty and trainees should be sought to understand the implications of potential understaffing on medical education; and 8) in academic medical ICUs, there is evidence that intensivist/patient ratios less favorable than 1:14 negatively impact education, staff well-being, and patient care.
authors.affiliation: Rhode Island Hospital Brown/Alpert Medical School, Providence, RI, USA. nicholas_ward@brown.edu
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Ward
authors.forename: Bekele
authors.initials: B
authors.lastname: Afessa
authors.forename: Ruth
authors.initials: R
authors.lastname: Kleinpell
authors.forename: Samuel
authors.initials: S
authors.lastname: Tisherman
authors.forename: Michael
authors.initials: M
authors.lastname: Ries
authors.forename: Michael
authors.initials: M
authors.lastname: Howell
authors.forename: Neil
authors.initials: N
authors.lastname: Halpern
authors.forename: Jeremy
authors.initials: J
authors.lastname: Kahn
mesh_terms: D002055:Burnout, Professional / Q000517:prevention & control; D003953:Diagnosis-Related Groups; D006801:Humans; D007362:Intensive Care Units; D007396:Internship and Residency; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D011787:Quality of Health Care; D013663:Teaching; D017216:Telemedicine; D014481:United States; D000078329:Workforce; D016526:Workload