title: Objective factors associated with physicians' and nurses' perceptions of intensive care unit capacity strain.
abstract: BACKGROUND
  Time-varying demand for critical care may strain the capacities of intensive care units (ICUs) to provide optimal care. Intensivists and ICU nurses may be the best judges of the strain on their ICU. Yet, it is not clear what ICU and hospital factors contribute to this perceived sense of strain among ICU providers.
  
  
  OBJECTIVE
  To identify measureable ICU and hospital factors associated with perceived strain by intensivists and ICU nurses.
  
  
  METHODS
  During a 6-month prospective cohort study, we surveyed nurses and physicians responsible for bed management regarding the ability of a 24-bed medical ICU (MICU) to provide optimal critical care. We simultaneously assessed time-varying ICU-level factors, including patient census, number of admissions, average patient acuity, number of interhospital transfer requests, and censuses of other hospital units. To identify factors associated with strain, we used an algorithm for covariate selection in regression models that selects variables that contribute sufficiently to model prediction to justify their inclusion.
  
  
  RESULTS
  Of 254 surveys, 226 (89%) were completed by 18 charge nurses and 17 physicians. On a scale of 1 to 10 (where a higher score indicated more strain), the median perceived strain score among nurses was 6 (interquartile range, 3-7) and among physicians was 5 (interquartile range, 3-7), with moderate correlation within days (interclass correlation coefficient, 0.45; 95% confidence interval: 0.30, 0.60). Average patient acuity, MICU census, number of MICU admissions, and general ward census were included in the most efficient model of strain perceived by nurses. Only MICU census was strongly associated with strain perceived by physicians.
  
  
  CONCLUSIONS
  A model containing commonly available metrics of ICU census, average patient acuity, and the proportion of new admissions has validity as a model of ICU nurses' perceived ICU capacity strain. However, only ICU census was associated with increased perceived capacity strain by physicians, highlighting the need for involvement of multiple stakeholder groups to improve our understanding of ICU capacity strain.
authors.affiliation: 1 Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Perelman School of Medicine.
authors.forename: Meeta Prasad
authors.initials: MP
authors.lastname: Kerlin
authors.forename: Michael O
authors.initials: MO
authors.lastname: Harhay
authors.forename: Kelly C
authors.initials: KC
authors.lastname: Vranas
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Cooney
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Ratcliffe
authors.forename: Scott D
authors.initials: SD
authors.lastname: Halpern
mesh_terms: D018806:APACHE; D001291:Attitude of Health Personnel; D001509:Bed Occupancy / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003422:Critical Care / Q000592:standards*; D064648:Critical Care Nursing / Q000592:standards*; D005260:Female; D006301:Health Services Needs and Demand; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016014:Linear Models; D008297:Male; D008505:Medical Staff, Hospital; D015999:Multivariate Analysis; D009745:Nursing, Supervisory; D010360:Patient Transfer / Q000706:statistics & numerical data; D011446:Prospective Studies; D011795:Surveys and Questionnaires