E J Yoo1, N Damaghi2, W G Shakespeare2, M S Sherman3. 1. Division of Pulmonary, Critical Care, and Sleep Medicine, Drexel University College of Medicine, Philadelphia, PA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA. Electronic address: erika.yoo@drexelmed.edu. 2. Department of Medicine, Drexel University College of Medicine, Philadelphia, PA. 3. Division of Pulmonary, Critical Care, and Sleep Medicine, Drexel University College of Medicine, Philadelphia, PA; Department of Medicine, Drexel University College of Medicine, Philadelphia, PA.
Abstract
PURPOSE: Although evidence supports the impact of intensivist physician staffing in improving intensive care unit (ICU) outcomes, the optimal coverage for progressive care units (PCU) is unknown. We sought to determine how physician staffing models influence outcomes for intermediate care patients. MATERIALS AND METHODS: We conducted a retrospective observational comparison of patients admitted to the medical PCU of an academic hospital during 12-month periods of high-intensity and low-intensity staffing. RESULTS: A total of 318 PCU patients were eligible for inclusion (143 high-intensity and 175 low-intensity). We found that low-intensity patients were more often stepped up from the emergency department and floor, whereas high-intensity patients were ICU transfers (61% vs 42%, P = .001). However, Mortality Probability Model scoring was similar between the 2 groups. In adjusted analysis, there was no association between intensity of staffing and hospital mortality (odds ratio, 0.84; 95% confidence interval, 0.36-1.99; P = .69) or PCU mortality (odds ratio, 0.96; 95% confidence interval, 0.38-2.45; P = .69). There was also no difference in subsequent ICU admission rates or in PCU length of stay. CONCLUSIONS: We found no evidence that high-intensity intensivist physician staffing improves outcomes for intermediate care patients. In a strained critical care system, our study raises questions about the role of the intensivist in the graded care options between intensive and conventional ward care.
PURPOSE: Although evidence supports the impact of intensivist physician staffing in improving intensive care unit (ICU) outcomes, the optimal coverage for progressive care units (PCU) is unknown. We sought to determine how physician staffing models influence outcomes for intermediate care patients. MATERIALS AND METHODS: We conducted a retrospective observational comparison of patients admitted to the medical PCU of an academic hospital during 12-month periods of high-intensity and low-intensity staffing. RESULTS: A total of 318 PCU patients were eligible for inclusion (143 high-intensity and 175 low-intensity). We found that low-intensity patients were more often stepped up from the emergency department and floor, whereas high-intensity patients were ICU transfers (61% vs 42%, P = .001). However, Mortality Probability Model scoring was similar between the 2 groups. In adjusted analysis, there was no association between intensity of staffing and hospital mortality (odds ratio, 0.84; 95% confidence interval, 0.36-1.99; P = .69) or PCU mortality (odds ratio, 0.96; 95% confidence interval, 0.38-2.45; P = .69). There was also no difference in subsequent ICU admission rates or in PCU length of stay. CONCLUSIONS: We found no evidence that high-intensity intensivist physician staffing improves outcomes for intermediate care patients. In a strained critical care system, our study raises questions about the role of the intensivist in the graded care options between intensive and conventional ward care.
Authors: David N Hager; Varshitha Tanykonda; Zeba Noorain; Sarina K Sahetya; Catherine E Simpson; Juan Felipe Lucena; Dale M Needham Journal: J Crit Care Date: 2018-05-19 Impact factor: 3.425
Authors: Rebeccah M Brusca; Catherine E Simpson; Sarina K Sahetya; Zeba Noorain; Varshitha Tanykonda; R Scott Stephens; Dale M Needham; David N Hager Journal: J Intensive Care Med Date: 2019-10-21 Impact factor: 3.510