Critical Care: ICU Management and Outcomes |

Impact of Night Time on Site Consultant Intensivist on Patient Outcomes in a Low Intensity Staffing Model ICU in a Tertiary Care Community Health Center FREE TO VIEW

Aditya Shah, MD; Vishal Shroff, MD; Samir Patel, MD; David Barounis, MD; Dana Villines
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Advocate Christ Medical Center, Oak Lawn, IL

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

Chest. 2016;150(4_S):288A. doi:10.1016/j.chest.2016.08.301
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SESSION TITLE: ICU Management and Outcomes

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 25, 2016 at 08:45 AM - 10:00 AM

PURPOSE: A paucity of literature exists with respect to published Intensive Care Unit (ICU) outcome measures in a mandated night intensivist model. Despite mixed data an increasing number of hospitals have begun to employ “an around the clock” in house intensivist staffing model. We aimed to determine how night time on site consultant intensivist staffing models influence patient outcomes. The aim of this study was to compare the impacts on patient outcomes namely mortality and ventilator days, by the presence of mandatory night time on site consultant intensivist.

METHODS: One medical ICU within a tertiary care health-care organization was used for the purpose of this retrospective cohort study. The study group comprised of patient population from July 2015 - November 2015 after the hiring of night time on site consultant intensivist. The control group comprised of patient population in the same time frame in the previous year July 2014 - November 2014, without the presence of night time on site consultant intensivist. The data collected from these 2 groups over the period included sex, age, APACHE IV score, ICU mortality, days on ventilator and ventilator index ratio as defined as a ratio of actual versus expected days on ventilator. A post hoc comparison was made after the addition of nighttime intensivists

RESULTS: The study included 1017 patients in the control group and 913 patients in the study group with 955 females and 973 males. Mean APACHE scores were 66.17±32.8 in the control group and 67.04±31.9 in the study group (p = 0.68). The study group had a lower ventilator day index than the control group (Χ2 = 0.98±0.09 v 0.75±0.06, p = 0.007) and the mortality was the same among the two groups, with 97 deaths (9.53%) in 2014-time frame as compared to 95 deaths (10.4%) in 2015 with a Χ2=0.40, p = 0.525. However, when these were further analyzed and differences made between deaths from failed CPR versus deaths from patients who did not receive CPR (withdrawal of care), a higher mortality from failed CPR was found in the 2014-time frame as compared to 2015, with the difference being statistically significant (Χ2 = 6.03, p = 0.014).

CONCLUSIONS: There are a few studies which have said in the past that there is so significant impact of on site night time on site consultant intensivist on an ICU with a high intensity staffing model. However, there are not many studies which necessitate the presence of on site night time on site consultant intensivist in a tertiary community center with a low intensity staffing model. In this retrospective study at a large tertiary care academic medical center, the addition of a night intensivist model improved multiple patient centered outcomes.

CLINICAL IMPLICATIONS: The implications going forward could be consideration of a on site 24 hour “round the clock” intensivist staffing model in a low intensity staffing Intensive Care Unit in a tertiary care community health center, as evidenced by improvement in outcomes as above.

DISCLOSURE: The following authors have nothing to disclose: Aditya Shah, Vishal Shroff, Samir Patel, David Barounis, Dana Villines

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