NYMC Faculty Publications
Beyond Capacity: An EAST Multicenter Mixed-Methods Study Exploring Surgeon Perceptions on Patient Ratios in Acute Care Surgery
Author Type(s)
Faculty
DOI
10.1136/tsaco-2025-001937
Journal Title
Trauma Surgery and Acute Care Open
Document Type
Article
Publication Date
11-13-2025
Department
Surgery
Keywords
Delivery of Health Care, Practice Patterns, Physicians', quality improvement, workload
Disciplines
Medicine and Health Sciences
Abstract
Background Optimal provider-to-patient (PtP) ratios in acute care surgery (ACS) remain undefined despite their importance for care quality and provider sustainability. This study aimed to understand surgeon perspectives on maximum ideal ratios across trauma, emergency general surgery (EGS) and surgical intensive care unit (SICU) services. Methods This multicenter mixed-methods study combined quantitative surveys and semistructured interviews with ACS surgeons at level I/II trauma centers across the USA (1 August 2023–19 April 2024). Service line census data were also collected. Interviews were recorded, transcribed and qualitative analysis performed; surveys were analyzed with descriptive statistics. Results Fifty-two interviews were completed. Survey response rate was 50.3% (212/421 eligible division leadership and faculty) from 40 centers across 24 states. The perceived maximum safe patient load for trauma and EGS was <20 patients when working independently, and up to 40 patients with full team support. SICU ratios were lower with most reporting ≤10 patients for independent coverage and ≤20 with team support. Regarding appropriate patient loads for junior residents and advanced practice providers, most respondents recommended ≤10 patients for trauma/EGS and ≤7 for SICU. For senior residents, most recommended ≤13 patients for trauma/EGS and ≤7 for SICU. Notably, 72% of centers exceeded their own leadership-recommended maximums for at least one service line. Qualitative analysis revealed patient acuity, team experience and competing demands as key workload modulators, with concerns about care quality degradation and burnout at higher ratios. Conclusions This study establishes potential upper threshold benchmarks for ACS PtP ratios with strong agreement across institutions. Division leadership should consider developing staffing models that account for patient acuity and service complexity while implementing escalation protocols for sustained high workloads. Current practices frequently exceed maximum ideal ratios, highlighting the need for evidence-based staffing guidelines that balance financial constraints with mounting evidence linking workload intensity and density to adverse outcomes. Level of evidence IV.
Recommended Citation
Wilson, D., Gellings, J., Coleman, J., Mukherjee, K., Bonne, S., Boltz, M., Hartwell, J., Bruns, B., Kurle, J., Hassan, M., Todd, S., Maqbool, B., Morse, B., Cripps, M., Patel, M., Margulies, D., Lilienstein, J., Aryan, N., Zarzaur, B., Bayouth, C., Porter, J., Staudenmayer, K., Mederos, D., Fasanya, C., Leneweaver, K., Jacobson, L., Farrell, M., Norwood, S., Cull, J., Hoth, J., Kamine, T., & Prabhakaran, K. (2025). Beyond Capacity: An EAST Multicenter Mixed-Methods Study Exploring Surgeon Perceptions on Patient Ratios in Acute Care Surgery. Trauma Surgery and Acute Care Open, 10 (4). https://doi.org/10.1136/tsaco-2025-001937
