Critical Care

[Morbc]

Hello, I want to know from anyone working in an ICU how many patients you are responsible for and to what extent?...Meaning total care from assessing/ordering/consults/notes per patient vs. assisting with all of the patients? Also I would like to know how many attendings there are per patient and if you have support from fellows/residents/interns and how many per patient? I have a job offer for a 12 bed ICU staffed with one attending (only contract attendings with different one each week) and a monthly intern for 12 hours. No other help besides nursing staff. Does this seem understaffed?

[andersenpa]

Sounds like you may get a chance to do a lot.

[coloradopa]

Hello, I want to know from anyone working in an ICU how many patients you are responsible for and to what extent?...Meaning total care from assessing/ordering/consults/notes per patient vs. assisting with all of the patients? Also I would like to know how many attendings there are per patient and if you have support from fellows/residents/interns and how many per patient? I have a job offer for a 12 bed ICU staffed with one attending (only contract attendings with different one each week) and a monthly intern for 12 hours. No other help besides nursing staff. Does this seem understaffed?

Depends on the acuity. We have 8 PAs and NPs to cover 20 beds 24/7 with 3-4 residents. The Daytime PA or NP takes up to 8 patients with 3 critically ill. The residents take the other 12. If you are talking really sick patients then that's too heavy. If they are not very sick then its still a lot. If you split them between the intern the six is reasonable. However, whats the plan for evenings, nights, weekends on the days the intern can't work (limited to 80 hours and six days per week). We have a lot of other support (fellows etc) and each other. It also depends on whether you are managing all the issues or critical care and only managing the vents and pressors.

[Morbc]

Right now it is running on one attending, the intern and then they are looking for one mid-level. It is the MICU so critically ill patients. I've talked to a person who worked in an ICU last year and for a 12 bed ICU each shift had an attending, fellow, several residents, and several interns (per shift). This ICU would only be the three of us. At night they only have one attending. The shifts are 12 hour shifts. I am thinking this ICU is way understaffed. The patients are critically ill and on vents, etc.

[coloradopa]

Right now it is running on one attending, the intern and then they are looking for one mid-level. It is the MICU so critically ill patients. I've talked to a person who worked in an ICU last year and for a 12 bed ICU each shift had an attending, fellow, several residents, and several interns (per shift). This ICU would only be the three of us. At night they only have one attending. The shifts are 12 hour shifts. I am thinking this ICU is way understaffed. The patients are critically ill and on vents, etc.

It really depends on the situation. It also depends on the what the attending is doing. Are they just doing ICU or are they doing pulmonary consults also. Basically one person can handle 6-8 patients depending on the acuity. Within the heading of acuity there is a wide range. The acuity of a community hospital may be much less than a tertiary medical center. A "stable" vent takes less time than someone with sepsis for example on two or three pressors. So theoretically an attending and an intern could handle things but in reality the intern isn't going to offer much. So theoretically a PA and a physician can handle a 12 bed ICU. If the attending has other duties then you are going to need more help. Also you have to think about how you are going to cover weekends, vacations etc. Finally the amount of procedures that you do dramatically affects the acuity and time needed.

 

Is it understaffed? Hard to say. There are plenty of 8-12 bed ICUs that are staffed with one intensivist (or a hospitalist depending on the size of the hospital). On the other hand our 14 bed MICU is staffed with an attending, fellow, five PA/NPs on rotating shifts and three residents. This allows for teaching, resident clinic etc.

[familygal]

On our MICU side (26 beds), we have two teams consisting of 1 attending and usually 1-2 midlevels for up to 13 patients per team. We do not have regular fellows or interns to help; it's just the attendings and midlevels. Our midlevels are responsible for basically everything, from assessing patients, presenting them during rounds, overseeing med students during rounds, ordering any type of testing/diagnostics, ordering consults and discussing with consulting teams, doing most of the procedures in the ICU, and troubleshooting throughout the day. We work 3 weekdays per week, and rotate weekends/holidays among us. At night, there is one fellow and midlevel for the entire MICU. And yes, our patients are VERY sick.

 

In my opinion about your situation, with experience, a PA + attending should be able to handle 12 ICU beds on most days. Plus you will have an intern. I agree with andersenpa that you would be getting great experience. Sometimes when there are too many interns, residents, med students, fellows, etc. the PA gets left in the dust to do the clerical order-entry work while the others learn the cool procedures of inserting lines, intubating, thoracentesis, ect, or they are on the front lines running the codes or crashing patients, when it could be you getting the experience of getting your feet wet!

[CCPA]

I agree with the above, it varies with acuity. I work nights, and I am the only provider available for 14 beds in a combined med/surg ICU. I also cover consults and admissions. The fellow or attending is backup from home, and there is one attending on for the unit. During the day there are 1-2 PA's or NP's, 1-2 Fellows, and 1-2 residents, an intern and an upper level. If you have experience then it is likely doable. At night I don't round and write a note on every patient, as they do during the day, but I still review everyone's chart.

[CCPA]

I agree with the above, it varies with acuity. I work nights, and I am the only provider available for 14 beds in a combined med/surg ICU. I also cover consults and admissions. The fellow or attending is backup from home, and there is one attending on for the unit. During the day there are 1-2 PA's or NP's, 1-2 Fellows, and 1-2 residents, an intern and an upper level. If you have experience then it is likely doable. At night I don't round and write a note on every patient, as they do during the day, but I still review everyone's chart.