SESSION TYPE: Improving Processes and Outcomes in Adult Critical Care
PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM
PURPOSE: Multiple studies have demonstrated improved outcomes in the intensive care unit (ICU) when care is guided by critical care-trained specialists (Intensivists). The impact of 24-hour Intensivist presence is less well known and the few studies to-date have not shown a significant mortality benefit. We hypothesized that patient outcomes such as mortality and length of stay (LOS), would improve after our ICU moved to a 24 hour Intensivist staffing model.
METHODS: This was a retrospective observational study. The 24 bed medical ICU at an academic tertiary referral center went to a 24-hour on-site Intensivist staffing model in June 2010. Routinely collected ICU outcomes data before and after the staffing change were analyzed.
RESULTS: Data from 1 year prior to the coverage change, and 1.5 years after, were analyzed. A total of 3593 admissions occurred over the 2.5-year study period. Among the 1439 admissions prior to the intervention there were 235 deaths with 365 deaths in the intervention cohort of 2519 admissions. The mortality rate decreased from 0.163 to 0.144 after the intervention, a near-significant improvement (p=0.051). Length of stay significantly decreased nearly one-half day, from 4.5 to 4.09 days (p=0.033).
CONCLUSIONS: 24 hour on-site Intensivist presence was associated with trend towards improved mortality and significantly reduced ICU length of stay. We recommend round-the-clock Intensivist presence in all large medical ICU’s. Large prospective studies are needed to confirm these findings.
CLINICAL IMPLICATIONS: These data suggest that the continuous intensivist staffing model may provide optimal patient care. Our results can provide physicians, hospital administrators and other stakeholders with guidance when making decisions about staffing in their individual institutions.
DISCLOSURE: The following authors have nothing to disclose: Eric Papierniak, Sandra Shaw, Hassan Alnuaimat, Ibrahim Faruqi
No Product/Research Disclosure InformationUniversity of Florida, Division of Pulmonary, Critical Care, and Sleep Medicine, Gainesville, FL