The correlation between intensive care unit attending physician continuity of care with financial and clinical outcomes

Abstract

Purpose “Attending rotations” on intensive care unit (ICU) services have been in place in most teaching hospitals for decades. However, the ideal frequency of patient care handoffs is unknown. Frequent attending physician handoffs could result in delays in care and other complications, while too few handoffs can lead to provider burnout and exhaustion. Therefore, we sought to determine the correlation between frequency of attending shifts with ICU charges, 30‐day readmission rates, and mortality rates. Methods We performed a retrospective cohort study at a large, urban, academic community hospital in Baltimore, MD. We included patients admitted into the cardiac or medical ICUs between September 1, 2012, and December 10, 2015. We tracked the number of attending shifts for each patient and correlated shifts with financial outcomes as a primary measure. Results For any given ICU length of stay, we found no distinct association between handoff frequency and charges, 30‐day readmission rates, or mortality rates. Conclusions Despite frequent handoffs in care, there was no objective evidence of care compromise or differences in cost. Further validation of these observations in a larger cohort is justified.

A Qualitative Study of Nurses' Perspectives on Neonatologist Continuity of Care

“…9,[12][13][14] Studies exploring the relationship of COC with clinical outcomes for inpatients, such as central venous catheter utilization, nutritional delivery, length of stay (LOS), readmission, and mortality, show mixed results. [15][16][17][18][19][20][21][22][23] Studies evaluating family-and staff-related outcomes show an association of COC with less anxiety, stress, and distrust for families; less inefficiency and moral distress for clinicians; and improved communication, family-staff relationships, and shared decision-making that affect both groups. [9][10][11][22][23][24][25][26][27][28] Attention to strategies for improving COC delivery in intensive care units (ICUs) in pediatric settings, including the neonatal intensive care unit (NICU), is increasing, especially given the complexity and chronicity of diseases encountered by this patient population.…”

“…Existing literature describes COC as longitudinal relationships with clinicians who have informational knowledge of the patient and their disease who provide cohesive clinical strategies and goals and consistent communication 9,12–14. Studies exploring the relationship of COC with clinical outcomes for inpatients, such as central venous catheter utilization, nutritional delivery, length of stay (LOS), readmission, and mortality, show mixed results 15–23. Studies evaluating family- and staff-related outcomes show an association of COC with less anxiety, stress, and distrust for families; less inefficiency and moral distress for clinicians; and improved communication, family–staff relationships, and shared decision-making that affect both groups 9–11,22–28.…”

Parental Perspectives on Neonatologist Continuity of Care

“…Studies examining patient outcomes related to continuity of attending physicians (defined as the same physician over time) in intensive care units (ICUs) show reduced central venous line utilization and increased nutritional delivery, 15,16 but show mixed results for length of stay (LOS), readmission, and mortality. [17][18][19][20] Few studies have focused on COC from neonatologists (hereafter referred to as neonatologist COC) of infants in NICUs. 15,16 As these infants often have complex clinical needs, prolonged LOS (often many months), and multiple transitions of providers, 15,[21][22][23] neonatologist COC may be especially critical.…”

“…Evaluations, applications, and recognized benefits of COC are diverse and, in some instances, limited in scope. Studies examining patient outcomes related to continuity of attending physicians (defined as the same physician over time) in intensive care units (ICUs) show reduced central venous line utilization and increased nutritional delivery,15,16 but show mixed results for length of stay (LOS), readmission, and mortality 17–20. Few studies have focused on COC from neonatologists (hereafter referred to as neonatologist COC) of infants in NICUs 15,16.…”