Education, Teaching, and Quality Improvement |

High vs Low Intensity Staffing in a Semi-Closed Medical Intensive Care Unit FREE TO VIEW

Matthew Schreiber, MD; Maria Luraschi; Hidenobu Shigemitsu
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Pulmonary/Critical Care, University of Nevada School of Medicine, Las Vegas, NV

Chest. 2014;146(4_MeetingAbstracts):498A. doi:10.1378/chest.1994794
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SESSION TITLE: Outcomes/Quality Control Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Intensive care staffing patterns are variable. The value of High intensity ICU staffing (HIIS) vs. low intensity ICU staffing (LIIS) remains in equipoise. While some studies demonstrate an association between staffing intensity and patient outcomes (i.e. mortality and length of stay), various clinical scenarios may confound the impact of staffing. Our study seeks to evaluate the impact of HIIS on patient outcomes in a “semi-closed” medical ICU.

METHODS: We conducted a prospective observational cohort study analyzing consecutive admissions to the University of Nevada School of Medicine medical ICU (MICU) teaching service at University Medical Center in Las Vegas, NV between 2/1/13 and 3/1/14. Subjects were stratified by attending coverage model with identical resident coverage. HIIS was defined as having 2 critical-care-trained attending physicians present in-hospital for 14 or more hours per day. LIIS was defines as having 1 critical care trained physician present for less than 10 hours per day. Demographic, clinical, and outcome data was collected and analyzed using Chi2, ANOVA, and descriptive statistics where appropriate.

RESULTS: 2126 subjects were observed with a mean age of 53. 58% were male with a mean (median) length of stay of 4.0 (2.0) days and mean mortality of 10.4%. When stratified by staffing model (HIIS vs. LIIS), no significant differences were seen for length of stay (4.0 vs. 4.3 days, p=0.2) or mortality (10.5 vs. 12.8%, p=0.09). Subjects remained in the MICU longer after being transferred from the teaching service to a hospitalist in the LIIS model (additional 1.7 vs. 0.8 days, p<0.001).

CONCLUSIONS: In our study of a semi-closed MICU, HIIS does not significantly impact length of stay or mortality but is associated with a shorter duration of MICU utilization after transfer from the teaching service.

CLINICAL IMPLICATIONS: Assessment of physician staffing in the MICU may be confounded by independent factors (i.e. inability to control length of stay in a semi-closed ICU). HIIS may result in patients being more readily accepted to a lower level of care by accepting physicians.

DISCLOSURE: The following authors have nothing to disclose: Matthew Schreiber, Maria Luraschi, Hidenobu Shigemitsu

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