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Multicenter Study
. 2025 Apr 1;53(4):e863-e873.
doi: 10.1097/CCM.0000000000006605. Epub 2025 Feb 26.

ICU Patient-to-Pharmacist Ratios: A Prospective, Multicenter Time-Motion Study

Mitchell S Buckley  1 , Susan E Smith  2 , Barbara Birriel  3 , John J Radosevich  4 , Amy L Dzierba  5 , Russel J Roberts  6 , Jeffrey F Barletta  7 , Hayley B Gershengorn  8 , Andrea Sikora  9   2 , Lars-Kristofer Peterson  10 , Ryan Bodkin  11 , David Kaufman  11 , Thomas Ardiles  12 , Suresh Uppalapu  13 , Allison J Tompeck  13 , Paul Dabrowski  13 , Letitia Close  14 , Heidi Brewer  15 , Ashlee Jontz  13 , Brenda Downs  16 , Lori A Cox  17 , Sheila A Alexander  18 , Katherine Harrison  19 , Robert MacLaren  20 ; Society of Critical Care Medicine Clinical Pharmacy and Pharmacology Practice Advancement Committee
Collaborators, Affiliations
Multicenter Study

ICU Patient-to-Pharmacist Ratios: A Prospective, Multicenter Time-Motion Study

Mitchell S Buckley et al. Crit Care Med. .

Abstract

Objectives: To evaluate the relationship among ICU patient-to-pharmacist ratio, perceived quality of patient care, and pharmacist burnout.

Design: A prospective, multicenter, time-motion study conducted over a 10-month period (from May 1, 2022, to February 28, 2023).

Setting: Adult ICU, PICU, or neonatal ICU.

Subjects: ICU clinical pharmacists.

Interventions: None.

Measurements and main results: Overall, 128 ICU pharmacists completed 703 unique time-motion observation days and recorded their time associated with direct/indirect patient care activities, Maslach Burnout Inventor survey scores, and perceived quality of patient care provided (5-point Likert scale). Total pharmacist time on direct and indirect patient care activities were 5.9 ± 1.9 and 3.3 ± 1.7 hours per shift, respectively. The number of assigned patients in the ICU and overall (ICU and non-ICU) per shift was 19.3 ± 12.9 and 23.4 ± 17.9, respectively. The overall frequency of pharmacist burnout was 38.1%. Burnout was associated with incremental increases in the number of assigned total patients (odds ratio [OR], 1.03; 95% CI, 1.01-1.05) and overtime worked (OR, 1.18; 95% CI, 1.03-1.35). Higher compared with lower perceived quality of patient care was associated with significantly smaller assigned ICU patients (17.0 ± 7.4 vs. 30.6 ± 23.8, respectively; p < 0.001). Additional direct patient care time allocated per patient was predictive of a high quality of care perception (OR, 1.53; 95% CI, 1.03-2.05). Burnout was inversely associated with high quality of care (OR, 0.59; 95% CI, 0.36-0.96). The ICU patient-to-pharmacist ratio between 16:1 and 19:1 was associated with the highest perceived quality of patient care and comprehensive patient assessment completion rates.

Conclusions: Critical care pharmacist practice models across healthcare institutions are inconsistent regarding patient assignments and time allocated toward direct and indirect patient care activities. The ICU patient-to-pharmacist ratio range between 16:1 and 19:1 may optimize quality of care and burnout risk at large academic institutions.

Keywords: burnout; critical care; intensive care; patient ratio; pharmacist; staffing.

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Conflict of interest statement

Dr. Smith’s institution received funding from the Agency for Healthcare Research and Quality. Drs. Roberts and Barletta received funding from Wolters Kluwer. Dr. Gershengorn’s institution received funding from the National Heart, Lung, and Blood Institute; she received funding from Gilead Sciences and the American College of Chest Physicians. Dr. Sikora received support for article research from the National Institutes of Health. Dr. Alexander’s institution received funding from the National Institute on Aging. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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