Continuous Mandatory Onsite Consultant Intensivists in the ICU

Abstract

An improved survival rate was observed only among medical patients admitted to the ICU with mandatory continuous access to a consultant intensivist, despite the presence of greater disease severity in the population admitted to this unit.

Improved Outcomes With Integrated Intensivist Consultation for Cardiac Surgery Patients

“…Continuous variables were described using means or medians where appropriate and compared using Student t tests or Wilcoxon-Mann-Whitney rank-sum tests, respectively. Categorical data were described using counts and proportions and compared using Pearson χ 2 or Fisher exact tests as appropriate. Using established PROM cutpoints, [21][22][23] the study team assessed whether the impact of the staffing model might differ by patient complexity and risk by conducting analyses for low-risk patients (PROM 0%-4%) and intermediate/high-risk patients (PROM > 4%) separately.…”

“…1 Implementation of intensivistdirected ICU models have shown improved outcomes in surgical, medical, and neurocritical care ICUs. [2][3][4][5] A recent retrospective analysis demonstrated improved survival associated with high-intensity staffing (ie, dedicated cardiac intensivist) in the cardiac ICU (CCU). 6 Appointment of an intensivist-directed team model and introduction of quality improvement interventions were associated with decreased mortality after cardiac surgery in a retrospective study of cardiac surgery ICU patients in an academic hospital.…”

Nighttime physician staffing improves patient outcomes: no

“…[4] Another study comparing two academic ICUs found that the ICU using nighttime intensivist staffing had lower risk-adjusted mortality rates. [5] However, neither establishes the causal effect of nighttime intensivist staffing. The before-after design cannot control for other ICU changes over time, and the comparison across two hospitals ignores the many differences between these hospitals and their patients.…”