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Hospitalists and intensivists in the medical ICU: a prospective observational study comparing mortality and length of stay between two staffing models.
J Hosp Med. 2012 Mar; 7(3):183-9.JH

Abstract

BACKGROUND

A shortage of critical care specialists or intensivists, coupled with expanding United States critical care needs, mandates identification of alternate qualified physicians for intensive care unit (ICU) staffing.

OBJECTIVE

To compare mortality and length of stay (LOS) of medical ICU patients cared for by a hospitalist or an intensivist-led team.

DESIGN

Prospective observational study.

SETTING

Urban academic community hospital affiliated with a major regional academic university.

PATIENTS

Consecutive medical patients admitted to a hospitalist ICU team (n = 828) with selective intensivist consultation or an intensivist-led ICU teaching team (n = 528).

MEASUREMENTS

Endpoints were ICU and in-hospital mortality and LOS, adjusted for patient differences with logistic and linear regression models and propensity scores.

RESULTS

The odds ratio adjusted for disease severity for in-hospital mortality was 0.8 (95% confidence interval [CI]: 0.49, 1.18; P = 0.23) and ICU mortality was 0.8 (95% CI: 0.51, 1.32; P = 0.41), referent to the hospitalist team. The adjusted LOS was similar between teams (hospital LOS difference 0.9 days, P = 0.98; ICU LOS difference 0.3 days, P = 0.32). Mechanically ventilated patients with intermediate illness severity had lower hospital LOS (10.6 vs 17.8 days, P < 0.001) and ICU LOS (7.2 vs 10.6 days, P = 0.02), and a trend towards decreased in-hospital mortality (15.6% vs 27.5%, P = 0.10) in the intensivist-led group.

CONCLUSIONS

The adjusted mortality and LOS demonstrated no statistically significant difference between hospitalist and intensivist-led ICU models. Mechanically ventilated patients with intermediate illness severity showed improved LOS and a trend towards improved mortality when cared for by an intensivist-led ICU teaching team.

Authors+Show Affiliations

Division of Hospital Medicine, Emory University School of Medicine, Emory University Hospital Midtown (EUHM), Atlanta, GA, USA. Kristin.Wise@emoryhealthcare.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22069304

Citation

Wise, Kristin R., et al. "Hospitalists and Intensivists in the Medical ICU: a Prospective Observational Study Comparing Mortality and Length of Stay Between Two Staffing Models." Journal of Hospital Medicine, vol. 7, no. 3, 2012, pp. 183-9.
Wise KR, Akopov VA, Williams BR, et al. Hospitalists and intensivists in the medical ICU: a prospective observational study comparing mortality and length of stay between two staffing models. J Hosp Med. 2012;7(3):183-9.
Wise, K. R., Akopov, V. A., Williams, B. R., Ido, M. S., Leeper, K. V., & Dressler, D. D. (2012). Hospitalists and intensivists in the medical ICU: a prospective observational study comparing mortality and length of stay between two staffing models. Journal of Hospital Medicine, 7(3), 183-9. https://doi.org/10.1002/jhm.972
Wise KR, et al. Hospitalists and Intensivists in the Medical ICU: a Prospective Observational Study Comparing Mortality and Length of Stay Between Two Staffing Models. J Hosp Med. 2012;7(3):183-9. PubMed PMID: 22069304.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hospitalists and intensivists in the medical ICU: a prospective observational study comparing mortality and length of stay between two staffing models. AU - Wise,Kristin R, AU - Akopov,Valery A, AU - Williams,Byron R,Jr AU - Ido,Moges S, AU - Leeper,Kenneth V,Jr AU - Dressler,Daniel D, Y1 - 2011/11/08/ PY - 2011/03/23/received PY - 2011/07/12/revised PY - 2011/08/15/accepted PY - 2011/11/10/entrez PY - 2011/11/10/pubmed PY - 2012/6/22/medline SP - 183 EP - 9 JF - Journal of hospital medicine JO - J Hosp Med VL - 7 IS - 3 N2 - BACKGROUND: A shortage of critical care specialists or intensivists, coupled with expanding United States critical care needs, mandates identification of alternate qualified physicians for intensive care unit (ICU) staffing. OBJECTIVE: To compare mortality and length of stay (LOS) of medical ICU patients cared for by a hospitalist or an intensivist-led team. DESIGN: Prospective observational study. SETTING: Urban academic community hospital affiliated with a major regional academic university. PATIENTS: Consecutive medical patients admitted to a hospitalist ICU team (n = 828) with selective intensivist consultation or an intensivist-led ICU teaching team (n = 528). MEASUREMENTS: Endpoints were ICU and in-hospital mortality and LOS, adjusted for patient differences with logistic and linear regression models and propensity scores. RESULTS: The odds ratio adjusted for disease severity for in-hospital mortality was 0.8 (95% confidence interval [CI]: 0.49, 1.18; P = 0.23) and ICU mortality was 0.8 (95% CI: 0.51, 1.32; P = 0.41), referent to the hospitalist team. The adjusted LOS was similar between teams (hospital LOS difference 0.9 days, P = 0.98; ICU LOS difference 0.3 days, P = 0.32). Mechanically ventilated patients with intermediate illness severity had lower hospital LOS (10.6 vs 17.8 days, P < 0.001) and ICU LOS (7.2 vs 10.6 days, P = 0.02), and a trend towards decreased in-hospital mortality (15.6% vs 27.5%, P = 0.10) in the intensivist-led group. CONCLUSIONS: The adjusted mortality and LOS demonstrated no statistically significant difference between hospitalist and intensivist-led ICU models. Mechanically ventilated patients with intermediate illness severity showed improved LOS and a trend towards improved mortality when cared for by an intensivist-led ICU teaching team. SN - 1553-5606 UR - https://www.unboundmedicine.com/medline/citation/22069304/Hospitalists_and_intensivists_in_the_medical_ICU:_a_prospective_observational_study_comparing_mortality_and_length_of_stay_between_two_staffing_models_ L2 - https://doi.org/10.1002/jhm.972 DB - PRIME DP - Unbound Medicine ER -