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The following is a summary of “Intensive care unit caseload and workload and their association with outcomes in critically unwell patients: a large registry-based cohort analysis,” published in the September 2024 issue of Critical Care by Zajic et al.

Overburdened healthcare professionals due to excessive or insufficient patient volumes and workloads can hinder processes, disrupt routines, and compromise the quality of care.

Researchers conducted a retrospective study to assess the association between caseload, workload, and patient outcomes in intensive care units (ICUs).

They analyzed the data from an Austrian ICU registry, including patients aged ≥18 years admitted to 144 Austrian ICUs between 2013 and 2022. A Cox proportional hazards model was used to estimate the association between ICU mortality, SAPS 3, ICU occupancy rates (caseload), and median TISS-28 per ICU (workload). Subgroup analyses were performed for ICU types, hospital care levels, and pre-COVID or intra-COVID periods.

The results showed 15,584 patients admitted to 144 ICUs were analyzed, compared to ICU caseloads of 76-100%, had no significant association between excessive ICU capacity utilization and mortality risk [HR (95% CI) 1.06 (0.99-1.15), P=0.110 for >100%]. However, lower utilization was associated with increased mortality risk [1.09 (1.02-1.16), P=0.008 for ≤50%; 1.10 (1.05-1.15), P<0.0001 for 51-75%]. Exceptions were significant associations for caseloads >100% during the intra-COVID period (2020-2022) [1.18 (1.06-1.30), P=0.001]. Compared to the reference category of median TISS-28 21-30, lower workloads (≤20) were linked with decreased mortality risk [0.88 (0.78-0.99), P=0.049], while higher workloads were not significantly associated with mortality risk. In local hospitals, high workloads (31-40, >40) were associated with increased mortality risk [1.09 (1.01-1.19), P=0.035; 1.28 (1.02-1.60), P=0.033].

They concluded that systems with adequate intensive care resources, mandatory staffing levels, high ICU caseloads, and workloads generally do not impact patient survival. However, exceeding planned capacities may increase mortality risk during exceptional circumstances, such as the COVID-19 pandemic. In smaller hospitals with lower staffing levels, high workloads in ICUs may be associated with increased mortality risk.

Source: ccforum.biomedcentral.com/articles/10.1186/s13054-024-05090-z