OBJECTIVE: Our objective was to assess the cost implications of changing the intensive care unit staffing model from on-demand presence to mandatory 24-hr in-house critical care specialist presence. DESIGN: A pre-post comparison was undertaken among the prospectively assessed cohorts of patients admitted to our medical intensive care unit 1 yr before and 1 yr after the change. Our data were stratified by Acute Physiology and Chronic Health Evaluation III quartile and whether a patient was admitted during the day or at night. Costs were modeled using a generalized linear model with log-link and γ-distributed errors. SETTING: A large academic center in the Midwest. PATIENTS: All patients admitted to the adult medical intensive care unit on or after January 1, 2005 and discharged on or before December 31, 2006. Patients receiving care under both staffing models were excluded. INTERVENTION: Changing the intensive care unit staffing model from on-demand presence to mandatory 24-hr in-house critical care specialist presence. MEASUREMENTS AND MAIN RESULTS: Total cost estimates of hospitalization were calculated for each patient starting from the day of intensive care unit admission to the day of hospital discharge. Adjusted mean total cost estimates were 61% lower in the post period relative to the pre period for patients admitted during night hours (7 pm to 7 am) who were in the highest Acute Physiology and Chronic Health Evaluation III quartile. No significant differences were seen at other severity levels. The unadjusted intensive care unit length of stay fell in the post period relative to the pre period (3.5 vs. 4.8) with no change in non-intensive care unit length of stay. CONCLUSIONS: We find that 24-hr intensive care unit intensivist staffing reduces lengths of stay and cost estimates for the sickest patients admitted at night. The costs of introducing such a staffing model need to be weighed against the potential total savings generated for such patients in smaller intensive care units, especially ones that predominantly care for lower-acuity patients.
OBJECTIVE: Our objective was to assess the cost implications of changing the intensive care unit staffing model from on-demand presence to mandatory 24-hr in-house critical care specialist presence. DESIGN: A pre-post comparison was undertaken among the prospectively assessed cohorts of patients admitted to our medical intensive care unit 1 yr before and 1 yr after the change. Our data were stratified by Acute Physiology and Chronic Health Evaluation III quartile and whether a patient was admitted during the day or at night. Costs were modeled using a generalized linear model with log-link and γ-distributed errors. SETTING: A large academic center in the Midwest. PATIENTS: All patients admitted to the adult medical intensive care unit on or after January 1, 2005 and discharged on or before December 31, 2006. Patients receiving care under both staffing models were excluded. INTERVENTION: Changing the intensive care unit staffing model from on-demand presence to mandatory 24-hr in-house critical care specialist presence. MEASUREMENTS AND MAIN RESULTS: Total cost estimates of hospitalization were calculated for each patient starting from the day of intensive care unit admission to the day of hospital discharge. Adjusted mean total cost estimates were 61% lower in the post period relative to the pre period for patients admitted during night hours (7 pm to 7 am) who were in the highest Acute Physiology and Chronic Health Evaluation III quartile. No significant differences were seen at other severity levels. The unadjusted intensive care unit length of stay fell in the post period relative to the pre period (3.5 vs. 4.8) with no change in non-intensive care unit length of stay. CONCLUSIONS: We find that 24-hr intensive care unit intensivist staffing reduces lengths of stay and cost estimates for the sickest patients admitted at night. The costs of introducing such a staffing model need to be weighed against the potential total savings generated for such patients in smaller intensive care units, especially ones that predominantly care for lower-acuity patients.
Authors: Peter J Pronovost; Derek C Angus; Todd Dorman; Karen A Robinson; Tony T Dremsizov; Tammy L Young Journal: JAMA Date: 2002-11-06 Impact factor: 56.272
Authors: J L Wagner; S R Alberts; J A Sloan; S Cha; J Killian; M J O'Connell; P Van Grevenhof; J Lindman; C G Chute Journal: J Natl Cancer Inst Date: 1999-05-19 Impact factor: 13.506
Authors: Ognjen Gajic; Bekele Afessa; Andrew C Hanson; Tami Krpata; Murat Yilmaz; Shehab F Mohamed; Jeffrey T Rabatin; Laura K Evenson; Timothy R Aksamit; Steve G Peters; Rolf D Hubmayr; Mark E Wylam Journal: Crit Care Med Date: 2008-01 Impact factor: 7.598
Authors: Anis Abdul Rauf; Kirsten Hall Long; Ognjen Gajic; Stephanie S Anderson; Lalithapriya Swaminathan; Robert C Albright Journal: J Intensive Care Med Date: 2008 May-Jun Impact factor: 3.510
Authors: Peter J Pronovost; Dale M Needham; Hugh Waters; Christian M Birkmeyer; Jonah R Calinawan; John D Birkmeyer; Todd Dorman Journal: Crit Care Med Date: 2004-06 Impact factor: 7.598
Authors: Marilyn T Haupt; Carolyn E Bekes; Richard J Brilli; Linda C Carl; Anthony W Gray; Michael S Jastremski; Douglas F Naylor; Maria Rudis PharmD; Antoinette Spevetz Md; Suzanne K Wedel; Mathilda Horst Md Journal: Crit Care Med Date: 2003-11 Impact factor: 7.598
Authors: Giovanni D Aletti; Karl C Podratz; James P Moriarty; William A Cliby; Kirsten Hall Long Journal: Gynecol Oncol Date: 2008-11-22 Impact factor: 5.482
Authors: David N Hager; Pranav Chandrashekar; Robert W Bradsher; Ali M Abdel-Halim; Souvik Chatterjee; Melinda Sawyer; Roy G Brower; Dale M Needham Journal: J Crit Care Date: 2017-08-03 Impact factor: 3.425
Authors: William Checkley; Greg S Martin; Samuel M Brown; Steven Y Chang; Ousama Dabbagh; Richard D Fremont; Timothy D Girard; Todd W Rice; Michael D Howell; Steven B Johnson; James O'Brien; Pauline K Park; Stephen M Pastores; Namrata T Patil; Anthony P Pietropaoli; Maryann Putman; Leo Rotello; Jonathan Siner; Sahul Sajid; David J Murphy; Jonathan E Sevransky Journal: Crit Care Med Date: 2014-02 Impact factor: 7.598