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Title: Variation in bed-to-physician ratios during weekday daytime hours in ICUs in Australia and New Zealand.
Author: Wunsch, Hannah
Pilcer, David
Litton, Edward
Anstey, Matthew
Garland, Allan
Gershengorn, Hayley
Issue Date: 2022
Publication Title: Critical Care Medicine
Volume: 50
Issue: 12
Start Page: 1737
End Page: 1747
Abstract: Objectives: To determine common "bed-to-physician" ratios during weekday hours across ICUs and assess factors associated with variability in this ratio. Design: Retrospective cohort study. Setting: All ICUs in Australia/New Zealand that participated in a staffing survey administered in 2017-2018. Patients: ICU admissions from 2016 to 2018. Methods: We linked survey data with patient-level data. We defined: 1) bed-to-intensivist ratio as the number of usually available ICU beds divided by the number of onsite weekday daytime intensivists; and 2) bed-to-physician ratio as the number of available ICU beds divided by the total number of physicians (intensivists + nonintensivists, including trainees). We calculated the median and interquartile range (IQR) of bed-to-intensivist ratio and bed-to-physician ratios during weekday hours. We assessed variability in each by type of hospital and ICU and by severity of illness of patients, defined by the predicted hospital mortality. Interventions: None. Measurements and main results: Of the 123 (87.2%) of Australia/New Zealand ICUs that returned staffing surveys, 114 (92.7%) had an intensivist present during weekday daytime hours, and 116 (94.3%) reported at least one nonintensivist physician. The median bed-to-intensivist ratio was 8.0 (IQR, 6.0-11.4), which decreased to a bed-to-physician ratio of 3.0 (IQR, 2.2-4.9). These ratios varied with mean severity of illness of the patients in the unit. The median bed-to-intensivist ratio was highest (13.5) for ICUs with a mean predicted mortality > 2-4%, and the median bed-to-physician ratio was highest (5.7) for ICUs with a mean predicted mortality of > 4-6%. Both ratios decreased and plateaued in ICUs with a mean predicted mortality for patients greater than 8% (median bed-to-intensivist ratio range, 6.8-8.0, and bed-to-physician ratio range of 2.4-2.7). Conclusions: Weekday bed-to-physician ratios in Australia/New Zealand ICUs are lower than the bed-to-intensivist ratios and have a relatively fixed ratio of less than 3 for units taking care of patients with a higher average severity of illness. These relationships may be different in other countries or healthcare systems.
Description: Includes data from BHS and WHCG
Internal ID Number: 02070
Health Subject: AUSTRALIA
Type: Journal Article
Appears in Collections:Research Output

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