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

The Mastering Intensive Care podcast is aimed to inspire and empower intensive care clinicians to bring their best self to the intensive care unit through conversations with such thought-provoking guests as Hayley Gershengorn. I genuinely believe we can help each other to improve, as both professionals and as people, so as to give the absolute best possible care to our patients.

Please help me to spread the message by simply emailing your colleagues, posting on social media or subscribing, rating and reviewing the podcast. To connect, 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 andrew@masteringintensivecare.com.

Thanks for listening.

Andrew Davies

--------------------

Show notes (people, organisations, resources and links mentioned in the episode):

Hayley Gershengorn profile: https://doctors.umiamihealth.org/provider/Hayley+Beth+Gershengorn/525503

Twitter handle for Hayley Gershengorn: @HBGMD

UK-based study conducted by Hayley and colleagues: https://www.ncbi.nlm.nih.gov/pubmed/28118657

Episode 35 with Paul Wischmeyer: http://masteringintensivecare.libsyn.com/episode-35-paul-wischmeyer-never-underestimate-the-simple-things-we-do-to-our-patients

Mastering Intensive Care podcast: http://masteringintensivecare.libsyn.com

Mastering Intensive Care page on Facebook: https://www.facebook.com/masteringintensivecare

Mastering Intensive Care at Life In The Fast lane: https://lifeinthefastlane.com/litfl/mastering-intensive-care

New Normal Project podcast: http://newnormalproject.libsyn.com/

Twitter handle for Andrew Davies: @andrewdavies66

Instagram handle for Andrew Davies: @andrewdavies66

Email Andrew Davies: andrew@masteringintensivecare.com

Romans 13:8-14 | "Wake Up and Die Right"