Implementation of 24/7 intensivist presence in the SICU

Wilden, Gwendolyn M. van der; Schmidt, Ulrich; Chang, Yuchiao; Bittner, Edward A.; Cobb, J. Perren; Velmahos, George C.; Alam, Hasan B.; Moya, Marc A. de; King, David R.

doi:10.1097/ta.0b013e31827880a8

Cited by 22 publications

(15 citation statements)

References 21 publications

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“…Further the study demonstrated nighttime staffing with an attending non-intensivist was associated with a slightly longer duration of mechanical ventilation (25). A similar study carried out in a surgical ICU population did not improve SICU morbidity or mortality but was associated with decreased blood product use and fewer radiological imaging studies (26). In a cluster randomized trial conducted in North America involving intensivist staffing, the outcomes in medical ICU patients were not worse despite a lower continuity of care by the intensivist, the outcomes in medical ICU patients were not worse and work schedules of intensivists receiving weekend breaks were better for the physicians (27).…”

Section: Accepted Manuscriptmentioning

confidence: 78%

The Intensive care unit specialist: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine

Amin

Fox-Robichaud

Divatia

et al. 2016

Journal of Critical Care

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Section: Accepted Manuscriptmentioning

confidence: 78%

The Intensive care unit specialist: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine

Amin

Fox-Robichaud

Divatia

et al. 2016

Journal of Critical Care

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“…While it has been shown that RVU generation is higher for surgeons who spend time providing critical care than those who do not, this was only found to be true in groups where the remaining members are clinically productive and billing diagnoses are vast beyond the operative diagnosis where critical care billing or E/M can be applied 18 . This model implies that there should be pooling of the group’s RVUs to increase overall reflection of productivity, but this model takes away each individual’s contribution and makes the individual dependent on group effort.…”

Section: Discussionmentioning

confidence: 97%

Does relative value unit–based compensation shortchange the acute care surgeon?

Schwartz¹,

Hui

Velopulos³

et al. 2014

Journal of Trauma and Acute Care Surgery

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BACKGROUND Studies have demonstrated that relative value units (RVUs) do not appropriately reflect cognitive effort or time spent in patient care, but RVU continues to be used as a standardized system to track productivity. It is unknown how well RVU reflects the effort of acute care surgeons. Our objective was to determine if RVUs adequately reflect increased surgeon effort required to treat emergent versus elective patients receiving similar procedures. METHODS A retrospective analysis using The American College of Surgeons’ National Surgical Quality Improvement Program 2011 data set was conducted. The control group consisted of patients undergoing elective colectomy, hernia repair, or biliary procedures as identified by Current Procedural Terminology. Comparison was made to emergent cases after being stratified to laparoscopic or open technique. Generalized linear models and logistic regression were used to assess specific outcomes, controlling for demographics and comorbidities of interest. The RVUs, operative time, and length of stay (LOS) were primary variables, with major/minor complications, mortality, and readmissions being evaluated as the relevant outcomes. RESULTS A total of 442,149 patients in the National Surgical Quality Improvement Program underwent one of the operative procedures of interest; 27,636 biliary (91% laparoscopic; 8.5% open), 28,722 colorectal (40.3% laparoscopic, 59.7% open), and 31,090 hernia (26.6% laparoscopic, 73.4% open) operations. Emergent procedures were found to have average RVU values that were identical to their elective case counterparts. Complication rates were higher and LOS were increased in emergent cases. Odds ratios for complications and readmissions in emergent cases were twice those of elective procedures. Mortality was skewed toward emergent cases. CONCLUSION Our data indicate that the emergent operative management for various procedures is similarly valued despite increased LOS, more complications, higher mortality risk, and subsequently increased physician attention. Our findings suggest that the RVU system for acute care surgeons may need to be reevaluated to better capture the additional work involved in emergent patient care.

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“…We performed two independent subgroup analysis to investigate the effect of country of study and the effect of a routine onsite intensivist cover overnight. between the presence of a night-time ICU doctor and patient survival (45)(46)(47), and a randomized control trial of nighttime intensivist staffing was not associated with either ICU/hospital mortality or length of stay (48). Two large databases across 49 American ICUs demonstrate that night-time ICU doctor staffing in addition to a high intensity daytime staffing did not reduce ICU mortality (49).…”

Section: Discussionmentioning

confidence: 99%