What number of patients should an intensivist simultaneously care for to optimise outcomes?Is a system with different day and night intensivists best for all? These are two of the questions discussed during the latest episode of Mastering Intensive Care in which Hayley Gershengorn shares her research and personal thoughts about resourcing our Intensive Care Units.
There is no easy answer to matching supply and demand in our workforces, not least because it is very different between the different health professionals that work in the ICU. The current resources available and the average daily demands seem to be the key decision-making drivers in many institutions and we probably have a lot to learn from analysing big data in this area. Doctors could learn a lot from how nurses staff themselves, and likely vice versa.
It is also vital that we find ways to delicately balance the needs of clinician wellness and job satisfaction with the obvious requirement for optimal patient outcomes. Turning up the screws on our staff by working them more often, in longer stretches and with an increasing number and acuity of patients, will inevitably increase burnout rates and lead to suboptimal patient outcomes. The more we can talk about this, and study it, as Hayley is doing, the better.
Hayley is an Associate Professor of Pulmonary and Critical Care Medicine at the University of Miami, Miller School of Medicine. She received her medical degree from Harvard Medical School and completed a residency in Internal Medicine at New York Presbyterian Hospital-Cornell and a fellowship in Pulmonary and Critical Care Medicine at New York Presbyterian Hospital-Columbia. Hayley’s research program focuses on the allocation of ICU resources and the impact such allocation has on the outcomes of critically ill patients. In particular, she is interested in understanding how (1) ICU staffing and (2) practices which may be tied to staffing, affect patient outcomes.
In addition to ICU resourcing Hayley talked about:
- Her medical training background
- Her initial study of mathematics
- A “gap” year she took as a management consultant
- What gives her the most enjoyment in intensive care
- Her thoughts on her own institution’s staffing model
- Why some people choose to be full-time nocturnal intensivists
- The concept of strain – on ICUs and on intensivists
- How we might better understand staff well-being
- The benefits to her of switching between clinical duties and research
- The advice her parents gave about achieving balance
- Her own lifestyle including exercise, movies, outdoor activities and sleep
- Bringing her best self to work often involves asking for help
- The benefits of having trainees always watching her
- Using group messaging service chats to attend to emotional needs
- The struggles of finding people to trust when moving institutions
- Thoughts on mentoring and coaching in intensive care medicine
- Her focus on human connection in communication
- Being open with families by answering personal questions
- Crediting her psychologist mother for helping her communicate
- Hayley Gershengorn profile and Twitter @HBGMD
- Persevering Through A Pandemic – 2 – It Was Inconceivable
- Association of Intensive Care Unit Patient-to-Intensivist Ratios With Hospital Mortality. [PMID 28118657]
- Episode 35 with Paul Wischmeyer
My genuine hope with the Mastering Intensive Care podcast is to inspire and empower you to bring your best self to the ICU by listening to the perspectives of such thought-provoking guests as Wes Ely. I passionately believe we can all get better, both as carers and as people, so we can do our absolute best for those patients whose lives are truly in our hands.
Feel free to leave a comment on the Facebook “mastering intensive care” page, on the LITFL episode page, on Twitter using #masteringintensivecare, or by sending me an email at andrewATmasteringintensivecare.com.
Further reading and listening
- Full podcast collection on LITFL and Libsyn
- More conversation on Twitter (@andrewdavies66) and Facebook