Sleep and Work in ICU Physicians During a Randomized Trial of Nighttime Intensivist Staffing*

Sleep and Work in ICU Physicians During a Randomized Trial of Nighttime Intensivist Staffing*

by Bakhru, Rita N.; Basner, Mathias; Kerlin, Meeta Prasad; Halpern, Scott D.; Hansen-Flaschen, John; Rosen, Ilene M.; Dinges, David F.; Schweickert, William D

Objectives: To compare sleep, work hours, and behavioral alertness in faculty and fellows during a randomized trial of nighttime in-hospital intensivist staffing compared with a standard daytime intensivist model.

Design: Prospective observational study. Setting: Medical ICU of a tertiary care academic medical center during a randomized controlled trial of in-hospital nighttime intensivist staffing. Patients: Twenty faculty and 13 fellows assigned to rotations in the medical ICU during 2012. Interventions: As part of the parent study, there was weekly randomization of staffing model, stratified by 2-week faculty rotation. During the standard staffing model, there were in-hospital residents, with a fellow and faculty member available at nighttime by phone. In the intervention, there were in-hospital residents with an in-hospital nighttime intensivist. Fellows and faculty completed diaries detailing their sleep, work, and well-being; wore actigraphs; and performed psychomotor vigilance testing daily.

Measurements and Main Results: Daily sleep time (mean hours [sd]) was increased for fellows and faculty in the intervention versus control (6.7 [0.3] vs 6.0 [0.2]; p < 0.001 and 6.7 [0.1] vs 6.4 [0.2]; p < 0.001, respectively). In-hospital work duration did not differ between the models for fellows or faculty. Total hours of work done at home was different for both fellows and faculty (0.1 [< 0.1] intervention vs 1.0 [0.1] control; p < 0.001 and 0.2 [< 0.1] intervention vs 0.6 [0.1] control; p < 0.001, respectively). Psychomotor vigilance testing did not demonstrate any differences. Measures of well-being including physical exhaustion and alertness were improved in faculty and fellows in the intervention staffing model.

Conclusions: Although no differences were measured in patient outcomes between the two staffing models, in-hospital nighttime intensivist staffing was associated with small increases in total sleep duration for faculty and fellows, reductions in total work hours for fellows only, and improvements in subjective well-being for both groups. Staffing models should consider how work duration, sleep, and well-being may impact burnout and sustainability.

Evaluation of a Measurement System to Assess ICU Team Performance*

Evaluation of a Measurement System to Assess ICU Team Performance*

by Dietz, Aaron S.; Salas, Eduardo; Pronovost, Peter J.; Jentsch, Florian; Wyskiel, Rhonda; Mendez-Tellez, Pedro Alejandro; Dwyer, Cynthia; Rosen, Michael A.  

Critical Care Medicine: December 2018 - Volume 46 - Issue 12 - p 1898–1905

Objective: Measuring teamwork is essential in critical care, but limited observational measurement systems exist for this environment. The objective of this study was to evaluate the reliability and validity of a behavioral marker system for measuring teamwork in ICUs.

 Design: Instances of teamwork were observed by two raters for three tasks: multidisciplinary rounds, nurse-to-nurse handoffs, and retrospective videos of medical students and instructors performing simulated codes. Intraclass correlation coefficients were calculated to assess interrater reliability. Generalizability theory was applied to estimate systematic sources of variance for the three observed team tasks that were associated with instances of teamwork, rater effects, competency effects, and task effects.

Setting: A 15-bed surgical ICU at a large academic hospital.

Subjects: One hundred thirty-eight instances of teamwork were observed. Specifically, we observed 88 multidisciplinary rounds, 25 nurse-to-nurse handoffs, and 25 simulated code exercises. Interventions: No intervention was conducted for this study.

Measurements and Main Results: Rater reliability for each overall task ranged from good to excellent correlation (intraclass correlation coefficient, 0.64–0.81), although there were seven cases where reliability was fair and one case where it was poor for specific competencies. Findings from generalizability studies provided evidence that the marker system dependably distinguished among teamwork competencies, providing evidence of construct validity.

Conclusions: Teamwork in critical care is complex, thereby complicating the judgment of behaviors. The marker system exhibited great potential for differentiating competencies, but findings also revealed that more context specific guidance may be needed to improve rater reliability.

A qualitative study exploring moral distress in the ICU team

A qualitative study exploring moral distress in the ICU team: The importance of Unit functionality and intrateam dynamics. Critical Care Medicine, April 2015, Vol. 43(4), p.823-31.

Bruce, C.R., et al.

http://journals.lww.com/ccmjournal/Abstract/2015/04000/A_Qualitative_Study_Exploring_Moral_Distress_in.13.aspx

 Our study objectives were to determine the key sources of moral distress in diverse critical care professionals and how they manage it in the context of team-based models.