Patients in alternate ICUs get less attention on rounds

A University of Pennsylvania study found that clinicians in surgical ICUs often visit patients in alternative wards at the end of rounds.

Patients housed in alternative intensive care units due to overcrowding face worse outcomes than those in the traditional ICU, and one of the causes may be that they receive less attention from clinicians, according to a new study.

Researchers at the Perelman School of Medicine at the University of Pennsylvania tracked 500 rounds within a Penn surgical ICU and found that caregivers spent 16% less time with “ICU boarders” than other ICU patients. Even when the study team adjusted for factors like age and health status, a significant gap remained.

Part of the reason, the study found, was that ICU patients housed in alternate wards were likely to be visited at the end of rounds, when clinical teams are most fatigued. About 71% of boarders were seen by caregivers in the last fifth of rounds, while just 13% of other ICU patients were seen in that same window.

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Critical care clinicians are already stretched thin without the addition of two disparate wards to manage. Recent research suggests that nearly half (45%) of ICU clinicians face severe burnout, and for those in pediatric intensive care the rate increased to 71%.

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Clinicians were also more likely to rely on “phone medicine” for the boarder patients. Doctors based in the “home” ICUs may also feel less of a sense of ownership over patients in the alternate ICUs, and nurses treating the boarder patients may also not have the full skill set to care for such vulnerable patients, according to the study.

“Together, all of these factors can create a ‘perfect storm’ leading to subpar clinical care of the critically ill patient,” José L. Pascual, M.D., an associate professor of traumatology, surgical critical care and emergency surgery at Penn and senior author on the study, said in an announcement.

As a result of the study, Penn’s surgical ICU teams are now encouraged to conduct rounds with boarder patients first and improve communication between nurses stationed at both wards, according to the announcement. Some are designating a nurse “generalist” who can care for ICU patients housed in either location. Further study is planned to see if any of these interventions bear fruit.