OBJECTIVES: 

To determine common “bed-to-physician” ratios during weekday hours across ICUs and assess factors associated with variability in this ratio.

DESIGN: 

Retrospective cohort study.

SETTING: 

All ICUs in Australia/New Zealand that participated in a staffing survey administered in 2017–2018.

PATIENTS: 

ICU admissions from 2016 to 2018.

METHODS: 

We linked survey data with patient-level data. We defined: 1) bed-to-intensivist ratio as the number of usually available ICU beds divided by the number of onsite weekday daytime intensivists; and 2) bed-to-physician ratio as the number of available ICU beds divided by the total number of physicians (intensivists + nonintensivists, including trainees). We calculated the median and interquartile range (IQR) of bed-to-intensivist ratio and bed-to-physician ratios during weekday hours. We assessed variability in each by type of hospital and ICU and by severity of illness of patients, defined by the predicted hospital mortality.

INTERVENTIONS: 

None.

MEASUREMENTS AND MAIN RESULTS: 

Of the 123 (87.2%) of Australia/New Zealand ICUs that returned staffing surveys, 114 (92.7%) had an intensivist present during weekday daytime hours, and 116 (94.3%) reported at least one nonintensivist physician. The median bed-to-intensivist ratio was 8.0 (IQR, 6.0–11.4), which decreased to a bed-to-physician ratio of 3.0 (IQR, 2.2–4.9). These ratios varied with mean severity of illness of the patients in the unit. The median bed-to-intensivist ratio was highest (13.5) for ICUs with a mean predicted mortality > 2–4%, and the median bed-to-physician ratio was highest (5.7) for ICUs with a mean predicted mortality of > 4–6%. Both ratios decreased and plateaued in ICUs with a mean predicted mortality for patients greater than 8% (median bed-to-intensivist ratio range, 6.8–8.0, and bed-to-physician ratio range of 2.4–2.7).

CONCLUSIONS: 

Weekday bed-to-physician ratios in Australia/New Zealand ICUs are lower than the bed-to-intensivist ratios and have a relatively fixed ratio of less than 3 for units taking care of patients with a higher average severity of illness. These relationships may be different in other countries or healthcare systems.

中文翻译：

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澳大利亚和新西兰 ICU 工作日白天时间床位与医生比例的变化*

目标： 

确定 ICU 工作日期间常见的“床位与医生”比率，并评估与该比率可变性相关的因素。

设计： 

回顾性队列研究。

环境： 

澳大利亚/新西兰所有参与2017-2018年人员配置调查的 ICU。

病人： 

2016 年至 2018 年 ICU 入院情况。

方法： 

我们将调查数据与患者层面的数据联系起来。我们将：1) 床位与重症监护医师比率定义为通常可用的 ICU 床位数量除以现场工作日日间重症监护医师的数量；2) 床位与医生比率，即可用 ICU 病床数除以医生总数（重症监护医师 + 非重症监护医师，包括实习生）。我们计算了工作日期间床位与重症监护医师比率和床位与医师比率的中位数和四分位距 (IQR)。我们根据医院和 ICU 的类型以及患者疾病的严重程度（由预测的医院死亡率定义）评估了每种疾病的变异性。

干预措施： 

没有任何。

测量和主要结果： 

在 123 个 (87.2%) 的澳大利亚/新西兰 ICU 中，返回了人员配置在调查中，114 人 (92.7%) 在工作日白天有重症监护医生在场，116 人 (94.3%) 报告至少有一名非重症医生。床位与重症监护医师比率的中位数为 8.0（IQR，6.0–11.4），而床位与医生比率则降至 3.0（IQR，2.2–4.9）。这些比率随单位中患者的平均疾病严重程度而变化。对于平均预测死亡率 > 2-4% 的 ICU，床位与重症监护医师比率中位数最高 (13.5)，对于平均预测死亡率 > 4% 的 ICU，床位与医生比率中位数最高 (5.7) –6%。在 ICU 中，这两个比率均下降并趋于稳定，患者的平均预测死亡率大于 8%（床位与重症监护医师比率的中位数范围为 6.8-8.0，床位与医生的比率范围为 2.4-2.7）。

结论： 

澳大利亚/新西兰 ICU 的工作日床位与医生的比率低于床位与重症监护病房的比率，并且对于照顾疾病平均严重程度较高的患者的单位而言，该比率相对固定，小于 3。这些关系在其他国家或医疗保健系统中可能有所不同。