(917) ICU Clinical Pharmacist-to-Patient Ratios: A Prospective, Multicenter Time-Motion Study

Introduction: The optimal intensive care unit (ICU) pharmacist practice model remains unknown. Identifying optimal ICU pharmacist workload is paramount to impact patient care, while mitigating burnout. This investigation aimed to establish a relationship among ICU pharmacist patient workloads, quality of patient care, and burnout.

Methods: A prospective, multicenter time-motion study of up to 8 observation periods (clinical shifts) was conducted over 10-months after IRB approval. Pharmacist participants were recruited through the SCCM Clinical Pharmacy & Pharmacology section. Perceived quality of patient care was assessed using a 5-point Likert scale. Concurrently, burnout was evaluated using the Maslach Burnout Inventory Human Services Survey for Medical Personnel survey. Participants recorded time on direct and indirect patient care activities, quality of care provided, and burnout during each observation period. The primary aim was to identify ICU pharmacist:patient ratios associated with the highest quality of care and lowest burnout.

Results: 703 total unique observation days were completed. 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 (including non-critically ill) per shift was 19.3  12.9 and 23.4  17.9, respectively. Higher perceived quality of care (Likert score 4 or 5) was associated with a significantly lower number of assigned ICU patients (17.0 ± 7.4 vs. 30.6 ± 23.8, respectively, p< 0.001) and less time spent on order verification (p < 0.001). The overall incidence of pharmacist burnout was 38.1%, with less burnout reported in higher (36.4%) over lower (47.0%) quality patient care groups (p=0.032). ICU pharmacist:patient ratios between 1:16.0 and 1:18.5 were associated with the highest patient care quality delivered and lowest burnout rates. Pharmacists worked 1.1  1.3 hours of overtime per shift; overtime was not significantly different between higher and lower quality groups (p=0.564).

Conclusions: Pharmacist time was mostly allocated to direct patient care activities. Overtime and burnout were common. Recommended ICU pharmacist:patient ratios may promote the highest perceived quality of patient care while mitigating burnout risk.