(101) Evaluating Interprofessional Staffing in Tertiary and Quaternary Pediatric Intensive Care Units

Introduction: Appropriate interprofessional staffing in pediatric intensive care units (PICUs) is necessary to provide care for critically ill children. However, few studies have evaluated interprofessional staffing in U.S. PICUs. We aimed to examine interprofessional staffing in U.S. tertiary and quaternary PICUs prior to the COVID-19 pandemic.

Methods: Post-hoc analysis of linked databases from a de novo national survey and the 2020 American Hospital Association database. We report descriptive statistics for physician, nurse, respiratory therapist, and pharmacist staffing.

Results: Our survey sample included 52 PICUs across 26 states. 37% of included PICUs were in children’s hospitals; 27% were rural referral centers; 96% were teaching hospitals. Most (25/52) PICUs were considered “large” (16-30 beds; 48%). Intensivists were available in 98% of PICUs; 73% had 24-hour intensivist staffing. In 62% of PICUs, intensivists worked for 7 consecutive days. In 75% of PICUs, intensivists had no other clinical responsibilities while on PICU service. Most PICUs employed exclusively registered (vs licensed practical) nurses (73%). For patients receiving invasive mechanical ventilation, a ratio of 1 nurse to 1 (42%) or 2 (54%) patients was common. For non-invasive mechanical ventilation, a ratio of 1:2 was nearly universal (92%). Of PICUs that provided extracorporeal membranous oxygenation (ECMO, n=37 [71% of 52]), most used a ratio of 2 nurses to 1 patient (18; 49%) or 1:1 (14; 38%). PICUs often had pharmacists available (92%), who all participated in clinical care during weekday day shifts. Yet, 38% reported pharmacists participated in care on weeknights, 60% during weekend days, and 35% during weekend nights. Respiratory therapists (RTs) were available in 98% of PICUs, with at least one RT present during weekday day, weeknight, weekend day, and weekend night shifts.

Conclusions: In this national sample of 52 PICUs, pediatric intensivists, registered nurses, pharmacists, and respiratory therapists were available to care for critically ill children. There was variation in intensivist staffing models, nurse to patient ratios, and off-hours pharmacist participation in care across PICUs. Future research should examine associations between these differences in staffing and patient outcomes.