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Excellent thread on ICU capacity:
ICUs = technology + experts in managing critically ill patients
(ht @Arrianna_Planey)
I'll add a bit more from my dissertation below on 1) trainees, 2) communication, and 3) inequality https://twitter.com/nickmmark/status/1281067680603107336
ICUs = technology + experts in managing critically ill patients
(ht @Arrianna_Planey)
I'll add a bit more from my dissertation below on 1) trainees, 2) communication, and 3) inequality https://twitter.com/nickmmark/status/1281067680603107336
1) Trainees
In many large, tertiary care hospitals, many of the doctors in the ICU are trainees.
In Canada, they found that "in nearly half of the ICUs, frontline, after-hour ICU care was delivered by physicians with less than 3 months of ICU training."
https://www.atsjournals.org/doi/full/10.1164/rccm.201006-0973ED
In many large, tertiary care hospitals, many of the doctors in the ICU are trainees.
In Canada, they found that "in nearly half of the ICUs, frontline, after-hour ICU care was delivered by physicians with less than 3 months of ICU training."
https://www.atsjournals.org/doi/full/10.1164/rccm.201006-0973ED
Another study noted that higher patient-doctor staffing ratios made teaching trainees more difficult.
https://journals.lww.com/ccmjournal/FullText/2012/02000/Perceived_effects_of_attending_physician_workload.5.aspx
https://journals.lww.com/ccmjournal/FullText/2012/02000/Perceived_effects_of_attending_physician_workload.5.aspx
Unsurprisingly, when trainees work long hours + have limited teaching, errors happen: https://www.nejm.org/doi/full/10.1056/nejmoa041406
This was particularly true during the COVID surge in April, trainees were pulled from all specialties.
One intern remarked, "I had never touched a ventilator before this." https://www.medscape.com/viewarticle/929607
One intern remarked, "I had never touched a ventilator before this." https://www.medscape.com/viewarticle/929607
2) Communication
Staffing impacts communication and decision-making. COVID has significantly impacted ICU communication w/ family members (research coming very soon
)
@danielalamasmd "No more visitors. When you leave today, you both need to say goodbye." https://www.nytimes.com/2020/03/24/opinion/coronavirus-hospital-visits.html
Staffing impacts communication and decision-making. COVID has significantly impacted ICU communication w/ family members (research coming very soon
)@danielalamasmd "No more visitors. When you leave today, you both need to say goodbye." https://www.nytimes.com/2020/03/24/opinion/coronavirus-hospital-visits.html
Before COVID, one study found that round the clock coverage by ICU faculty impacted end-of-life communication and decision-making
@MichaelWilsonMD @ogi_gajic https://journal.chestnet.org/article/S0012-3692(13)60144-0/fulltext
@MichaelWilsonMD @ogi_gajic https://journal.chestnet.org/article/S0012-3692(13)60144-0/fulltext
Another study with ICU providers highlighted how hand-offs (when the care of patient is handed off to another ICU provider) impacted decisions about life-sustaining treatment
@MichaelWilsonMD @ogi_gajic https://link.springer.com/article/10.1007/s00134-013-2896-x
@MichaelWilsonMD @ogi_gajic https://link.springer.com/article/10.1007/s00134-013-2896-x
My dissertation found that families were most able to make informed choices about life-sustaining treatments when they had continuity in who communicated with them. Hand-offs were sources of miscommunications, errors, and frustration.
3) Racial and SES Inequities
The core of my dissertation research was understanding inequality. I found trainee involvement and communication (as a outcome of ICU staffing) were clearly implicated in racial and SES inequities in end-of-life experiences.
The core of my dissertation research was understanding inequality. I found trainee involvement and communication (as a outcome of ICU staffing) were clearly implicated in racial and SES inequities in end-of-life experiences.
And ICU staffing has already been implicated in COVID inequalities https://mobile.twitter.com/KatieHauschildt/status/1278521972620754944
ICU capacity doesn't mean beds.
It means capacity to provide ICU-level care. ICU staffing is the absolute center of ICU-level care. It matters for patients' survival of COVID
AND
it matters for patients who do not survive https://twitter.com/KatieHauschildt/status/1246556100608090116
It means capacity to provide ICU-level care. ICU staffing is the absolute center of ICU-level care. It matters for patients' survival of COVID
AND
it matters for patients who do not survive https://twitter.com/KatieHauschildt/status/1246556100608090116
Have to add: @DeenaKCosta @juliaflynch @erin__ice have done excellent work on shortages in staffing https://twitter.com/juliaflynch/status/1270680159222403072
