Measurement of Resident Workload in Paediatric Intensive Care

Objective: To measure the workload of residents in a paediatric intensive care unit (PICU) and to compare this value with the possible explanatory variables "nine equivalents of nursing manpower use score" (NEMS), length of stay (LOS), patient age and severity of illness at admission.

Methods: This was a prospective study in a tertiary, interdisciplinary neonatal-paediatric intensive care unit. In 2010 and 2011, residents estimated their workload for each patient they looked after at admission and then twice a day (morning and night shift) (minor workload 0-30 minutes, medium >30-90 minutes, high >90 minutes). The following demographic and illness severity parameters were also collected prospectively: age, LOS, NEMS, Paediatric Index of Mortality (PIM2), and main diagnosis at admission.

Results: There were 2,513 admissions to PICU. Independent predictors of residents' workload were LOS (coefficient in multiple regression 8.9, p <0.0001) and NEMS (coefficient 1.4, p <0.0001). R2 of 0.928 indicated a strong overall relationship. Severity of illness at admission and patient age did not explain overall workload for the whole patient stay in PICU.

Conclusions: NEMS, a therapeutic intervention score, and LOS are both independent predictors of clinical workload of residents in PICU. The correlation with LOS means that workload depends mainly on routine procedures (rounds, discussions with parents, administrative tasks) unrelated to the severity of illness. After calibration, LOS or NEMS, two widely used measures, may be used to calculate resident workload.