PURPOSE:There is evidence that coverage of critically ill patients by critical care trained physicians, improves outcomes and reduces costs. Less is known about the effect of home call versus in-house call by critical care fellows on the quality of care and outcomes of patients admitted to the intensive care unit (ICU) during evening and overnight times.
METHODS:Data was collected from chart review from January 2006 to June 2006 on patients admitted to the medical ICU from 5:00 pm to 7:00 am when there was a home call system (group 1) and compared to a similar time frame from January 2007 to June 2007 when fellows were taking call in house(group 2). Severity of illness and predicted mortality was calculated using simplified acute physiology expanded score II. Primary outcome was mortality and secondary outcomes were ICU length of stay (LOS) and hospital LOS. Data was collected on incidence of acute renal failure, reintubation, readmission to ICU, invasive procedures and titration of vasopressors from admission until 7:00am on the day of admission.
RESULTS:Data on 143 patients was collected for group 1 and 110 patients for group 2. Patients in group 1 had lower mortality compared to group 2 (10% versus 25% p=0.0008), However group 2 had higher severity of illness and predicted mortality (19.3%, SD: 20.2 vs. 30.7%, SD: 28.2, p=0.0002). ICU and hospital LOS were not significantly different (8.04 days versus 6.99 days, p=0.38 and 10.52 days versus 10.25, p=0.83). When stratified by predicted mortality on admission, patients in group 2 had more active intervention, lower rates of reintubation and readmission to ICU and faster weaning of vasopressors. However, mortality and LOS were not different.
CONCLUSION:In house call resulted in faster weaning of vasopressors and fewer adverse outcomes compared to home call when patients were adjusted for predicted mortality. There was no difference in mortality and LOS overall and within severity subgroups.
CLINICAL IMPLICATIONS:In house call by critical care fellows may result in better patient outcomes.
DISCLOSURE:Georgios Chrysochoou, No Financial Disclosure Information; No Product/Research Disclosure Information