Workforce Shortage, Aging Population Strain ICUs; Issues Discussed at Society of Critical Care Medicine's 31st Critical Care Congress

1/29/2002

From: Dana Woods or Kris Pleiman, 949-362-2050, both of the American Association of Critical-Care Nurses (AACN); Lynne Marcus of the American College of Chest Physicians, 847-498-1400 (ACCP); Marchant Wentworth of the American Thoracic Society, 202-785-3355 (ATS); Katie Lundberg or Tracy Paulsen, 619-525-6636, both of the Society of Critical Care Medicine (SCCM)

SAN DIEGO, Jan. 29 -- The following was released today by the Society of Critical Care Medicine:

Intensive care units (ICUs) staffed by critical care experts provide better patient outcomes and are more cost effective than units without these specialists; however, because of the current workforce crisis, many ICUs do not have enough qualified professionals.

"In the absence of a sufficient number of appropriately trained physicians, nurses, pharmacists and respiratory therapists, patients in the ICU may be placed at higher risk and hospital resources are wasted," says Ann E. Thompson, M.D., president of the Society of Critical Care Medicine (SCCM).

Dr. Thompson and a number of other critical care leaders spoke today at a SCCM press briefing in conjunction with the 31st Annual Critical Care Congress in San Diego.

"We have abundant evidence that care in the ICU is far from ideal. The more thinly spread specially trained physicians and nurses are, the greater the risk of irreparable harm," says Dr. Thompson, professor of anesthesiology, critical care medicine and pediatrics, and director of pediatric critical care medicine at Children's Hospital of Pittsburgh. "The cost of care is greater than it needs to be and that is probably sufficient to be increasing the cost of care to everybody. A big piece of inpatient cost is related to intensive care."

Sharon Rounds, M.D., secretary-treasurer of the American Thoracic Society (ATS), adds that if ICU usage stays the same and if the number of critical care physicians continues to decline, "in the year 2010, it will be virtually impossible to provide appropriate care for critically ill patients." But, ICU usage is expected to increase as baby boomers age.

Aging population will lead to record number of visits to ICUs "In the next 20 years, the people who will need the most intense care are going to be the baby boomers," says Sidney Stuart Braman, M.D., president of the American College of Chest Physicians (ACCP). "Only about 35 percent of patients in ICUs have the input of a physician who is specifically trained in providing critical care. According to a recent assessment, more than 75 percent of ICUs in the country do not have a full-time intensivist. In the future, we are going to be at an abysmally low level of staffing."

"Though we are facing difficult times, this crisis has brought together the healthcare providers who have an interest in the critically ill," says Dr. Braman, professor of medicine and division director of pulmonary and critical care medicine at Brown Medical School in Providence, R.I.

The four societies, SCCM, ATS, ACCP and the American Association of Critical-Care Nurses (AACN) have banded together to speak on behalf of patients who require critical care services. The organizations have authored "The Critical Care Workforce Partnership Position Statement: The Aging of the U.S. Population and Increased Need for Critical Care Services."

"We can cure people, but we need to have detailed scrutiny, careful attention and a multidisciplinary approach in carrying patients through critical illness," says Dr. Thompson. "If there are no people to do this, then we will have a crisis."

Nursing shortage impacts ICU The biggest issue facing AACN today is the nursing shortage. "Some conservative estimates indicate a shortage of 500,000 nurses in the next five to 10 years, while others are predicting a shortage of 750,000," says organization President Michael L. Williams, MSN, RN, CCRN. "These numbers are for the United Sates, but the crisis is global."

"The shortage is primarily due to the aging of nurses, declining enrollments in nursing schools and deteriorating work place conditions. The impact of the nursing shortage crisis is widespread, however, it is more pronounced in specialty nursing such as critical care, which requires the most highly skilled and experienced nurses. Historically, critical care has been able to recruit from other units in the hospital. We could shift people around. That strategy will not work this time because there simply are not enough nurses," explains Williams, assistant professor of nursing at Eastern Michigan University in Ypsilanti. "As the grows, we will see more surgeries are being canceled, longer emergency department waits and more patients not being admitted because a hospital bed isn't available."

"Critical care nurses always provide expert care, even in trying times. In the face of the nursing shortage, I expect that the nurse's role could evolve to that of care coordinators," predicts Williams. As the shortage worsens, there will be a point where it will not be humanly possible for nurses to provide the level of care they are accustomed to providing for their highly vulnerable, critically ill patients. This is the concern we hear most often from our member nurses."

Pharmacists also face shortage, jeopardizing patient safety "Pharmacists in the ICU save lives and reduce costs," says Maria Rudis, PharmD, a clinical pharmacist practicing in the ICU. "When pharmacists make ICU rounds with the physicians, there are fewer adverse drug events, fewer medication errors and fewer drug interactions."

American Society of Health System Pharmacists surveys report hospital pharmacy vacancy rates were 15 percent in 1999, 21.5 percent in 2000, and 23 percent in 2001. Another workforce study reports the shortage is worse in institutional practice, including hospitals, and rural settings show vacancy rates reaching 29 percent. "This shortage affects a lot of ICU patients," comments Rudis.

Because a pharmacist-to-patient ratio has not been legislated, hospitals may admit more patients than the hospital pharmacy can effectively handle. When this happens, clinical pharmacists are pulled off ICUs to distribute medications elsewhere in the hospital. "When the clinical pharmacist is removed from the intensive care unit, the drug optimization roll falls on physicians and nurses who both already have designated roles that require a 100 percent effort," Rudis explains.

Legislation in Congress is designed to increase the number of pharmacists by providing financial aid to students, faculty and pharmacy schools. If passed, the Pharmacy Education Aid Act of 2001 would also make pharmacists eligible to have student loans forgiven and would provide scholarships to pharmacy students. "What critical care pharmacists really need is more residencies and fellowship training programs in critical care," Rudis explains.

Steps to resolve workforce shortage The Societies recommend the following:

A multifaceted approach to help ease the workforce crisis. The steps include: -- Public and physician enlightenment about the workforce shortage. -- Federal programs to entice more physicians and nurses into entering critical care. School loans assistance programs and more funding for graduate medical education should be established for those entering the critical care field. -- Take action to improve the working conditions in critical care units and improve compensation in this high stress environment where "burn out" is pervasive. -- An informational campaign explaining the benefits of specializing in critical care aimed at program directors in internal medicine and general surgical programs. -- Fund more training programs.

Strategies of recruitment and retention to curtail nurse shortages by: -- Targeted recruitment of men and minorities. -- Recruitment of middle school and high school students along with counselor education. -- Federal funding increases and loan forgiveness for nursing students. -- Legislation to address mandatory overtime and workplace quality of life, which affects retention.

The Society of Critical Care Medicine says in order to recruit and retain intensivists, it must be acknowledged by payers, regulators and colleagues in other fields that intensivists will be present in ICUs, integrated smoothly into the care team and given the responsibility and authority necessary to provide excellent care. Dr. Thompson adds that minimizing documentation burdens can save up to four hours daily, freeing healthcare workers to care for patients.

The Society of Critical Care Medicine is the leading professional organization dedicated to ensuring excellence and consistency in the practice of critical care medicine. With more than 9,500 members worldwide, the Society is the only professional organization devoted exclusively to the advancement of multidisciplinary, multi-professional intensive care through excellence in patient care, professional education, public education, research and advocacy. Members of the Society include intensivists, critical care nurses, critical care pharmacists, clinical pharmacologists, respiratory therapists and other professionals, which may include technicians, social workers, dieticians and members of the clergy.

The American Association of Critical-Care Nurses (AACN) is the largest specialty nursing association in the world with approximately 65,000 members. Its international headquarters is located in Aliso Viego, Calif. Founded in 1969, the Association now has more than 250 chapters worldwide and is working toward a healthcare system driven by the needs of patients and families, where critical care nurses make their optimal contribution. More information about AACN is available at www.aacn.org or by calling 800-899-AACN.

The American College of Chest Physicians, located in Northbrook, Ill., has nearly 15,000 members in over 100 countries worldwide who specialize in various multidisciplinary areas of chest medicine. The organization seeks to accomplish its mission and vision works by providing physicians, researchers, and healthcare practitioners with such resources as: continuing education courses and products.

The American Thoracic Society founded in 1905, is an independently incorporated, international, educational and scientific society which focuses on respiratory and critical care medicine. Today, the Society has approximately 13,500 members, 25 percent of whom are from outside the United States. The Society's members help prevent and fight respiratory disease around the globe through research, education, patient care, and advocacy. The Society's long-range goal is to decrease morbidity and mortality from respiratory disorders and life-threatening acute illnesses.