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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
Author(s) -
Wise Kristin R.,
Akopov Valery A.,
Williams Byron R.,
Ido Moges S.,
Leeper Kenneth V.,
Dressler Daniel D.
Publication year - 2012
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.972
Subject(s) - intensivist , medicine , rapid response team , intensive care unit , observational study , emergency medicine , odds ratio , staffing , logistic regression , confidence interval , prospective cohort study , intensive care medicine , nursing
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. Journal of Hospital Medicine 2011;. © 2011 Society of Hospital Medicine