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

Abstract

OBJECTIVES: To evaluate the relationship among ICU patient-to-pharmacist ratio, perceived quality of patient care, and pharmacist burnout. DESIGN: A prospective, multicenter, time-motion study conducted over a 10-month period (from May 1, 2022, to February 28, 2023). SETTING: Adult ICU, PICU, or neonatal ICU. SUBJECTS: ICU clinical pharmacists. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: 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. CONCLUSIONS: 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.