ICU Patient-to-Pharmacist Ratios: A Prospective, Multicenter Time-Motion Study

• Published in: Critical care medicine Vol. 53; no. 4; p. e863
• Main Authors: Buckley, Mitchell S, Smith, Susan E, Birriel, Barbara, Radosevich, John J, Dzierba, Amy L, Roberts, Russel J, Barletta, Jeffrey F, Gershengorn, Hayley B, Sikora, Andrea, Peterson, Lars-Kristofer, Bodkin, Ryan, Kaufman, David, Ardiles, Thomas, Uppalapu, Suresh, Tompeck, Allison J, Dabrowski, Paul, Close, Letitia, Brewer, Heidi, Jontz, Ashlee, Downs, Brenda, Cox, Lori A, Alexander, Sheila A, Harrison, Katherine, MacLaren, Robert
• Format: Journal Article
• Language: English
• Published: United States 01.04.2025
• Subjects: Adult; Burnout, Professional - epidemiology; Female; Humans; Intensive Care Units - organization & administration; Intensive Care Units - statistics & numerical data; Male; Middle Aged; Pharmacists - psychology; Pharmacists - statistics & numerical data; Prospective Studies; Quality of Health Care; Time and Motion Studies; critical care; pharmacist; intensive care; burnout; patient ratio; staffing
• ISSN: 1530-0293
• DOI: 10.1097/CCM.0000000000006605

To evaluate the relationship among ICU patient-to-pharmacist ratio, perceived quality of patient care, and pharmacist burnout. A prospective, multicenter, time-motion study conducted over a 10-month period (from May 1, 2022, to February 28, 2023). Adult ICU, PICU, or neonatal ICU. ICU clinical pharmacists. None. Overall, 128 ICU pharmacists completed 703 unique time-motion observation days and recorded their time associated with direct/indirect patient care activities, Maslach Burnout Inventor survey scores, and perceived quality of patient care provided (5-point Likert scale). Total pharmacist time on direct and indirect patient care activities were 5.9 ± 1.9 and 3.3 ± 1.7 hours per shift, respectively. The number of assigned patients in the ICU and overall (ICU and non-ICU) per shift was 19.3 ± 12.9 and 23.4 ± 17.9, respectively. The overall frequency of pharmacist burnout was 38.1%. Burnout was associated with incremental increases in the number of assigned total patients (odds ratio [OR], 1.03; 95% CI, 1.01-1.05) and overtime worked (OR, 1.18; 95% CI, 1.03-1.35). Higher compared with lower perceived quality of patient care was associated with significantly smaller assigned ICU patients (17.0 ± 7.4 vs. 30.6 ± 23.8, respectively; p < 0.001). Additional direct patient care time allocated per patient was predictive of a high quality of care perception (OR, 1.53; 95% CI, 1.03-2.05). Burnout was inversely associated with high quality of care (OR, 0.59; 95% CI, 0.36-0.96). The ICU patient-to-pharmacist ratio between 16:1 and 19:1 was associated with the highest perceived quality of patient care and comprehensive patient assessment completion rates. Critical care pharmacist practice models across healthcare institutions are inconsistent regarding patient assignments and time allocated toward direct and indirect patient care activities. The ICU patient-to-pharmacist ratio range between 16:1 and 19:1 may optimize quality of care and burnout risk at large academic institutions.