Interprofessional Staffing Pattern Clusters in U.S. ICUs.

To identify interprofessional staffing pattern clusters used in U.S. ICUs. Latent class analysis. Adult U.S. ICUs. None. None. We used data from a staffing survey that queried respondents (n = 596 ICUs) on provider (intensivist and nonintensivist), nursing, respiratory therapist, and clinical pharmacist availability and roles. We used latent class analysis to identify clusters describing interprofessional staffing patterns and then compared ICU and hospital characteristics across clusters. We identified three clusters as optimal. Most ICUs (54.2%) were in cluster 1 ("higher overall staffing") characterized by a higher likelihood of good provider coverage (both intensivist [onsite 24 hr/d] and nonintensivist [orders placed by ICU team exclusively, presence of advanced practice providers, and physicians-in-training]), nursing leadership (presence of charge nurse, nurse educators, and managers), and bedside nursing support (nurses with registered nursing degrees, fewer patients per nurse, and nursing aide availability). One-third (33.7%) were in cluster 2 ("lower intensivist coverage & nursing leadership, higher bedside nursing support") and 12.1% were in cluster 3 ("higher provider coverage & nursing leadership, lower bedside nursing support"). Clinical pharmacists were more common in cluster 1 (99.4%), but present in greater than 85% of all ICUs; respiratory therapists were nearly universal. Cluster 1 ICUs were larger (median 20 beds vs. 15 and 17 in clusters 2 and 3, respectively; p < 0.001), and in larger (> 250 beds: 80.6% vs. 66.1% and 48.5%; p < 0.001), not-for-profit (75.9% vs. 69.4% and 60.3%; p < 0.001) hospitals. Telemedicine use 24 hr/d was more common in cluster 3 units (71.8% vs. 11.7% and 14.1%; p < 0.001). More than half of U.S. ICUs had higher staffing overall. Others tended to have either higher provider presence and nursing leadership or higher bedside nursing support, but not both.

Gershengorn HB ，Costa DK ，Garland A ，Lizano D ，Wunsch H ... -  《-》

Interprofessional Team Staffing in U.S. Intensive Care Units.

Garland A ，Costa D ，Wunsch H ，Dzierba AL ，Lizano D ，Gershengorn H ... -  《-》

ICU Staffing in the United States.

The last national estimates of US ICU physician staffing are 25 years old and lack information about interprofessional teams. How are US adult ICUs currently staffed? We conducted a cross-sectional survey (May 4, 2022-February 2, 2023) of adult ICU clinicians (targeting nurse/physician leadership) contacted using 2020 American Hospital Association (AHA) database information and, secondarily, through professional organizations. The survey included questions about interprofessional ICU staffing availability and roles at steady state (pre-COVID-19). We linked survey data to hospital data in the AHA database to create weighted national estimates by extrapolating ICU staffing data to nonrespondent hospitals based on hospital characteristics. The cohort consisted of 596 adult ICUs (response rates: AHA contacts: 2.1%; professional organizations: unknown) with geographic diversity and size variability (median, 20 beds; interquartile range, 12-25); most cared for mixed populations (414 [69.5%]), yet medical (55 [9.2%]), surgical (70 [11.7%]), and specialty (57 [9.6%]) ICUs were well represented. A total of 554 (93.0%) had intensivists available, with intensivists covering all patients in 75.6% of these and onsite 24 h/d in one-half (53.3% weekdays; 51.8% weekends). Of all ICUs, 69.8% had physicians-in-training and 77.7% had nurse practitioners/physician assistants. For patients on mechanical ventilation, nurse to patient ratios were 1:2 in 89.6% of ICUs. Clinical pharmacists were available in 92.6%, and respiratory therapists were available in 98.8%. We estimated 85.1% (95% CI, 85.7%-84.5%) of hospitals nationally had ICUs with intensivists, 51.6% (95% CI, 50.6%-52.5%) had physicians-in-training, 72.1% (95% CI, 71.3%-72.9%) had nurse practitioners/physician assistants, 98.5% (95% CI, 98.4%-98.7%) had respiratory therapists, and 86.9% (95% CI, 86.4%-87.4%) had clinical pharmacists. For patients on mechanical ventilation, 86.4% (95% CI, 85.8%-87.0%) used 1:2 nurses/patients. We found that intensivist presence in adult US ICUs has greatly increased over 25 years. Intensivists, respiratory therapists, and clinical pharmacists are commonly available, and each nurse usually provides care for two patients on mechanical ventilation. However, team composition and workload vary.

Gershengorn HB ，Garland A ，Costa DK ，Dzierba AL ，Fowler R ，Kramer AA ，Liu VX ，Lizano D ，Scales DC ，Wunsch H ... -  《-》

Impact of nursing policy on securing intensive care unit nurse staffing and in-hospital mortality.

This study aimed to evaluate changes in intensive care unit nurse staffing after the introduction of the government's nursing policy, and the relationship between ICU nurse staffing levels and in-hospital mortality. A retrospective cohort study. This study used data from the Health Insurance Review and Assessment Service and included all patients admitted to adult ICUs at general and tertiary hospitals in Korea from 2016 to 2020. The primary variables of interest in this study were the level and overall trend change in the outcome variables after introducing the nursing policy; the nurse-to-bed ratio in the ICUs was evaluated. The secondary variable of interest was the relationship between nurse staffing levels and in-hospital mortality. Interrupted time-series analysis and generalized estimating equation models were used to evaluate the primary and secondary variables of interest. After the nursing policy was introduced, the nursing grades in the ICUs increased, especially in tertiary hospitals. The change at the time of the introduction of each policy was not statistically significant; however, after the introduction, the number of hospital beds per nurse decreased. In-hospital deaths of patients in ICUs increased as the number of beds per nurse increased (odds ratio [OR]: 1.17, 95 % confidence interval [CI]: 1.12-1.21) and decreased as the number of experienced nurses increased (OR: 0.97, 95 % CI: 0.96-0.98). The introduction of a nursing policy centered on financial support for medical institutions led to an increase in nurse hiring, leading to improved nursing grades. However, the results of introducing these policies differed by medical institution and region, and disparities between medical institutions appear to have widened further. Experienced nurses are important for better outcomes for patients admitted to ICUs, and continuous policy efforts are needed to secure and maintain sufficient nurses.

Han KT ，Kim S 《-》

Tobacco Product Use and Associated Factors Among Middle and High School Students - National Youth Tobacco Survey, United States, 2021.

Gentzke AS ，Wang TW ，Cornelius M ，Park-Lee E ，Ren C ，Sawdey MD ，Cullen KA ，Loretan C ，Jamal A ，Homa DM ... -  《MMWR SURVEILLANCE SUMMARIES》