Assessment of physician training and prediction of workforce needs in paediatric cardiac intensive care in the United States

Abstract Objective: To assess the training and the future workforce needs of paediatric cardiac critical care faculty. Design: REDCap surveys were sent May−August 2019 to medical directors and faculty at the 120 US centres participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database. Faculty and directors were asked about personal training pathway and planned employment changes. Directors were additionally asked for current faculty numbers, expected job openings, presence of training programmes, and numbers of trainees. Predictive modelling of the workforce was performed using respondents’ data. Patient volume was projected from US Census data and compared to projected provider availability. Measurements and main results: Sixty-six per cent (79/120) of directors and 62% (294/477) of contacted faculty responded. Most respondents had training that incorporated critical care medicine with the majority completing training beyond categorical fellowship. Younger respondents and those in dedicated cardiac ICUs were more significantly likely to have advanced training or dual fellowships in cardiology and critical care medicine. An estimated 49–63 faculty enter the workforce annually from various training pathways. Based on modelling, these faculty will likely fill current and projected open positions over the next 5 years. Conclusions: Paediatric cardiac critical care training has evolved, such that the majority of faculty now have dual fellowship or advanced training. The projected number of incoming faculty will likely fill open positions within the next 5 years. Institutions with existing or anticipated training programmes should be cognisant of these data and prepare graduates for an increasingly competitive market.

Download Full-text

Workforce demographics and unit structure in paediatric cardiac critical care in the United States

Cardiology in the Young ◽

10.1017/s1047951121004753 ◽

2021 ◽

pp. 1-5

Author(s):

Robin V. Horak ◽

Shasha Bai ◽

Bradley S. Marino ◽

David K. Werho ◽

Leslie A. Rhodes ◽

...

Keyword(s):

United States ◽

Critical Care ◽

Heart Surgery ◽

Age Groups ◽

The United States ◽

Work Hours ◽

Full Time ◽

Full Time Equivalent ◽

Unit Structure ◽

Cardiac Critical Care

Abstract Objective: To assess current demographics and duties of physicians as well as the structure of paediatric cardiac critical care in the United States. Design: REDCap surveys were sent by email from May till August 2019 to medical directors (“directors”) of critical care units at the 120 United States centres submitting data to the Society of Thoracic Surgeons Congenital Heart Surgery Database and to associated faculty from centres that provided email lists. Faculty and directors were asked about personal attributes and clinical duties. Directors were additionally asked about unit structure. Measurements and main results: Responses were received from 66% (79/120) of directors and 62% (294/477) of contacted faculty. Seventy-six percent of directors and 54% of faculty were male, however, faculty <40 years old were predominantly women. The majority of both groups were white. Median bed count (n = 20) was similar in ICUs and multi-disciplinary paediatric ICUs. The median service expectation for one clinical full-time equivalent was 14 weeks of clinical service (interquartile range 12, 16), with the majority of programmes (86%) providing in-house attending night coverage. Work hours were high during service and non-service weeks with both directors (37%) and faculty (45%). Conclusions: Racial and ethnic diversity is markedly deficient in the paediatric cardiac critical care workforce. Although the majority of faculty are male, females make up the majority of the workforce younger than 40 years old. Work hours across all age groups and unit types are high both on- and off-service, with most units providing attending in-house night coverage.

Download Full-text

Guidelines for the Management of Intravascular Catheter-Related Infections

Infection Control and Hospital Epidemiology ◽

10.1086/501893 ◽

2001 ◽

Vol 22 (4) ◽

pp. 222-242 ◽

Cited By ~ 97

Author(s):

Leonard A. Mermel ◽

Barry M. Farr ◽

Robert J. Sherertz ◽

Issam I. Raad ◽

Naomi O'Grady ◽

...

Keyword(s):

Critical Care ◽

The United States ◽

Underlying Disease ◽

Critical Care Medicine ◽

Intravascular Catheter ◽

Coagulase Negative Staphylococci ◽

Pulmonary Artery Catheters ◽

Potential Pathogen ◽

Adults And Children ◽

Healthcare Epidemiology

These guidelines from the Infectious Diseases Society of America (IDSA), the American College of Critical Care Medicine (for the Society of Critical Care Medicine), and the Society for Healthcare Epidemiology of America contain recommendations for the management of adults and children with, and diagnosis of infections related to, peripheral and nontunneled central venous catheters (CVCs), pulmonary artery catheters, tunneled central catheters, and implantable devices. The guidelines, written for clinicians, contain IDSA evidence-based recommendations for assessment of the quality and strength of the data. Recommendations are presented according to the type of catheter, the infecting organism, and the associated complications.Intravascular catheter-related infections are a major cause of morbidity and mortality in the United States. Coagulase-negative staphylococci,Staphylococcus aureus, aerobic gram-negative bacilli, andCandida albicansmost commonly cause catheter-related bloodstream infection. Management of catheter-related infection varies according to the type of catheter involved. After appropriate cultures of blood and catheter samples are done, empirical iv antimicrobial therapy should be initiated on the basis of clinical clues, the severity of the patient's acute illness, underlying disease, and the potential pathogen (s) involved. In most cases of nontunneled CVC-related bacteremia and fungemia, the CVC should be removed.

Download Full-text