Healthcare worker (HCW) workload is a modifiable factor with strong relationships to both HCW well-being and patient safety. Team-based care is the gold standard for the treatment of critically ill patients in the intensive care unit (ICU). The robust body of evidence suggests that high workloads in the ICU are significant drivers of medication errors and HCW burn-out. While ICU physicians and nurses have developed workload standards in siloed efforts to create safe conditions, these analyses have omitted the interprofessional ICU team that includes critical care pharmacists, dietitians, respiratory therapists, advanced practice providers, and occupational/physical therapists. To date, no workload studies have evaluated the interdependent nature of the ICU team. Moreover, most workload metrics that hospital administrators use to make decisions do not reflect how work is actually conducted at the ICU bedside. We will build a workload visualization tool (Data-dRiven ICU Volume intErvention [DRIVE] dashboard) that will continuously analyze EHR data to provide multi-layered, time-tracking summaries that connect patient-level data to workload for the ICU team (Aim 1). The goal of DRIVE is to serve as a quantitative display of ICU team workload with metrics that directly reflect HCW and patient safety. In Aim 2, we will test a data-driven workload implementation framework (ICU Professional Resource Optimization [ICU-PRO]). In the ICU-PRO use case, we will assess the impact of a critical care pharmacist workload optimization intervention on medication errors and HCW safety. The rationale for this work is the results of the Optimizing Team Integration of Critical Care Pharmacists (OPTIM) study, which included >30,000 ICU patients from 64 centers that found that a high patient care workload for pharmacists was independently associated with increased mortality and length of stay, even after adjusting for relevant confounders such as disease severity and nurse ratio. Moreover, this study was the first to link a single healthcare profession workload (i.e., pharmacy) to patient outcomes in the context of the entire ICU team. The long-term goal is to improve safety and quality through optimization of ICU team workload. The central hypothesis is that optimized workloads are associated with improved HCW and patient safety. This innovative approach will explore previously undefined relationships for ICU workload and patient outcomes.
Funder: Society of Critical Care Medicine
Amount: $100,000
PI: Susan Smith, College of Pharmacy