Surgical ‘ICU boarders’ get less attention from physicians, caregivers

Editor's Note

Surgical ICU patients boarding in alternative ICUs because of overcrowding are often seen at the end of rounds, receive fewer face-to-face assessments from physicians, and are given less bedside attention by ICU provider teams, this study finds.

The researchers found that:

• caregivers spent about 16% less time on rounds with boarder patients
• boarders were far more likely to be visited by caregiver teams at the end of rounds, when teams were more fatigued--71% of boarders were seen in the last fifth of rounds, compared to 13% of non-boarders
• more boarders meant more use of “phone medicine” than face-to-face assessment.

Possible causes for the shortfall in rounding care include:

• the distance between the home-ICU and boarding-ICU places a burden on home-ICU based providers
• home-ICU care teams may feel a reduced sense of "ownership" of patients housed in other ICUs
• nursing staff in boarding-ICUs may not have the full skill set needed for optimal care of their boarders.

Together, all of these factors can lead to subpar clinical care of critically ill patients, the authors say.

Surgical Intensive Care Unit (SICU) patients “boarding” in ICUs other than the designated home unit have been shown to suffer increased rates of complications. We hypothesized that ICU rounding practices are different when SICU patients are housed in home vs. boarding ICUs.