Critical Care: Critical Care - ICU Management |

Nighttime Onsite Fellow Coverage of Medical ICU (MICU): Impact on Patient Outcomes FREE TO VIEW

Yuriy Takhalov, MD; John Kileci, MD; Anne Sutherland
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Rutgers-NJMS, West New York, NJ

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):221A. doi:10.1016/j.chest.2016.08.234
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SESSION TITLE: Critical Care - ICU Management

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Increasing number of medical intensive care units (MICU) are adopting the practice of nighttime Intensivist staffing despite lack of data in the literature. While nighttime attending staffing of the MICU has been studied, nighttime Intensivist fellow in-training coverage of the MICU and its impact on patient outcomes has not been well established in the literature. We are attempting to look at nighttime staffing of MICU with fellows in-training, and its effect on patient outcomes.

METHODS: We are undertaking a retrospective study of 2 years of admissions to the University Hospital MICU, 1 academic year prior, and 1 academic year after implementation of 24/7 Fellow coverage of the ICU. We are presenting an interim analysis of the 60 days before (control group) and 60 days after (intervention group) the addition of an in-house night fellow coverage to the existing day fellow coverage. The primary outcome was patients’ mortality and length of stay in the MICU. Secondary outcomes were patients’ length of stay in the hospital, in-hospital mortality, and rates of readmission to the ICU.

RESULTS: A total of 271, of a planned 1800 patients were included in this interim analyses: 151 before and 120 after the 24/7 fellow staffing. Baseline characteristics including age, sex, vasopressor use, and mechanical ventilator support were similar between the two groups. Source of admission differed between the two groups, as more patients from the wards (31% vs. 25%) and fewer patients from the emergency room (52% vs. 67%) were likely to be admitted in the intervention group. ICU mortality, in-hospital mortality and hospital length of stay was similar between the two groups. ICU length of stay was significantly reduced in the intervention group compared with the control group, 3.2 days vs. 5.1 days respectively

CONCLUSIONS: In this interim analysis of 24/7 fellow in-training staffing of the MICU did not improve mortality, but was associated with a decrease in MICU length of stay.

CLINICAL IMPLICATIONS: The clinical implications based on the preliminary data may possibly change the way pulmonary critical care fellowship training programs staff their MICU at night.

DISCLOSURE: The following authors have nothing to disclose: Yuriy Takhalov, John Kileci, Anne Sutherland

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