PURPOSE: To compare the impact of intensivist staffing on resuscitation bundle compliance and overall sepsis mortality in a tertiary referral center.
METHODS: All septic patients identified using the Surviving Sepsis Campaign severe sepsis / septic shock screening criteria from September 1, 2007 to June 2010 were reviewed for the impact of sepsis presentation time, and intensivist staffing on resuscitation bundle compliance and overall mortality. Data in our Surviving Sepsis Campaign database was extracted to determine bundle compliance, timing of sepsis presentation, and mortality.
RESULTS: Two daytime intensivists (0900-2100) were compared to one nighttime intensivist (2100-0900) regarding resuscitation bundle compliance and mortality. For the day shift, there were n=482 septic patients with an all-or-none resuscitation bundle compliance of 26.55% and a mortality rate of 15.98%. Interestingly, the night shift saw n=246 with a compliance of 32.11% and a mortality rate of 21.54%. Using the Fisher’s exact test, the p-value for bundle compliance was 0.069 between the two groups and the p-value for overall mortality difference between the two groups was p=0.041. Since both resuscitation bundle compliance and overall mortality were higher with the nighttime one intensivist, comparison between those patients who were compliant with the resuscitation bundle and died to those who were non-compliant with the resuscitation bundle and died were analyzed using the Fisher’s exact test. 12/116 during the daytime and 15/64 during the nighttime who met all resuscitation bundle elements had died with p-value of 0.039. 65/289 during the daytime and 38/129 at nighttime did not achieve all-or-none resuscitation bundle and died (p=0.145).
CONCLUSIONS: Comparison of differences between two intensivists during the day and one intensivist at night revealed a statistically higher mortality rate of 5.57% despite a higher resuscitation bundle compliance (5.56%) with the night intensivist. Further evaluation revealed compliance with the resuscitation bundle and mortality showed an increase of 8.99% and 3.77% in mortality if non-compliant with the bundle in both day and night shifts covered by intensivists, respectively.
CLINICAL IMPLICATIONS: Critical care physician staffing, timing of sepsis admissions, and bundle compliance may all impact the septic patient's overall survival
DISCLOSURE: Donald Maxwell: Consultant fee, speaker bureau, advisory committee, etc.: Edwards Lifesciences
The following authors have nothing to disclose: Heather Leinbach, Cathy Merritt, Brenda Wynne, Lorry Carrigan
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