280: Potential Impact of Reduced Critical Care Pharmacist-to-Patient Ratios: An Optim Subgroup Analysis

Introduction: Consensus on the ideal critical care pharmacist (CCP)-to-patient ratio is lacking. At a large US academic medical center eight CCPs cover eight critical care service lines with a median CCP-to-patient ratio of 1:23. The center is constructing a new campus featuring multiple 32-bed intensive care units (ICUs), each divided into two 16-bed neighborhoods. This upcoming enhancement presents the potential to lower the CPP-to-patient ratio to 1:16. This study aimed to assess the relationship between CCP-to-patient ratios and patient outcomes, offering insight into optimal staffing strategies for CCPs. Methods: This retrospective, observational study is a sub-analysis of a single large academic medical center’s data obtained from the OPTIM study. Patients admitted to five ICUs between 8/14/2023 to 12/31/2023 were included. Patients were divided into groups based on their median CCP-to-patient ratio. The primary outcome was mortality. The secondary outcomes were ICU readmission, ICU and hospital length of stay (LOS). Results: A total of 1238 patients comprising 6698 patient days were included with 350 (28.3%) patients in the CCP-to-patient ratio of ≤ 1:16 group and 888 (71.7%) in the CCP-to-patient ratio of > 1:16 group. Most patients were admitted to the trauma ICU (32.2%) followed by the neuro ICU (27%) with a total median ICU LOS of 3.3 1.8 – 6.6 days. The median SOFA and MRC scores within 24 hours of admission were 3 1 – 6 and 8.5 5 – 13, respectively. The overall median CCP-to-patient ratio was 1:24 1:16 – 1:60. A CCP-to-patient ratio of ≤ 1:16 was associated with a reduction in mortality compared to a ratio of > 1:16 (23 (6.6%) vs 96 (10.8%) p = 0.023). ICU and hospital LOS were shorter in the ≤ 1:16 group (2.3 1.4 – 4.7 vs 3.8 2.0 – 7.6 days, p < 0.001 and 8.1 4.5 – 13.3 vs 9.6 5.4 – 17.8 days, p = 0.004 respectively). No difference was seen in ICU readmission rates. Conclusions: A CCP-to-patient ratio of ≤ 1:16 was associated with a reduction in mortality and shorter ICU and hospital LOS, highlighting the potential benefits of optimal CCP staffing. Further investigation is warranted to find the ideal CCP-to-patient ratio and assess its broader impact on patient outcomes.