We sought to determine whether there is a mortality difference when comparing patients admitted to the intensive care unit after-hours under direct care of board-certified intensive care physicians compared to other critical care providers (ie. non-intensivist physician providers, physician assistants, and moonlighting residents) with available supervision. Other critical care providers have after-hour supervision by board-certified intensivists available via the phone consistent with recommendations from the Leapfrog Group.
We performed a retrospective study of all patients admitted consecutively to our intensive care unit (ICU) after-hours initially to either an intensivist or other critical care provider. Based on pre-existing after-hours staffing patterns within our ICU we were able to compare data between our two defined provider groups. Pre-determined sample size was calculated in order to achieve a statistical power of 80%. In-hospital mortality, ICU mortality, hospital length of stay, ICU length of stay, and overall mortality were examined. Logistic regression analysis was performed to adjust for severity of disease.
A total of 1542 patients were analyzed over a forty month time frame. There was no statistical difference between critical care physicians and other critical care providers in regards to hospital mortality (23.8% vs 22.6 %; p 0.64), ICU mortality (20.5% vs 17.1%; p 0.23), and ICU length of stay (162.4h vs 170.8h, p 0.75). APACHE II scores were not statistically different (18.98 vs 18.56; p 0.40).
There is no difference in mortality or length of stay in a broad range of critically ill patients admitted to a tertiary care center ICU after-hours regardless of initial care provided via an intensivist or highly skilled supportive provider under supervision of a critical care intensivist.
Our study cannot fully support recommendations regarding continuous after-hours in-house ICU physician staffing by intensivists. It does support a system based approach to ICU patient care with available intensivists as recommended by the Leapfrog Group. Future randomized controlled trials with a similar comparison and broader scale should be considered.
Francis Maguire, No Financial Disclosure Information; No Product/Research Disclosure Information