Improved Outcomes With Integrated Intensivist Consultation for Cardiac Surgery Patients

Sultan, Omer W; Boland, Lori L.; Kinzy, Tyler G.; Melamed, Roman; Seatter, Susan C.; Farivar, Robert S.; Kirkland, Lisa L.; Mulder, Maximilian

doi:10.1177/1062860618766614

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…One hundred five studies of 657 articles (16%) identified by date and keywords criteria search met inclusion criteria for analysis (Fig. 1) (2, 13–116) and were published in 55 different journals ( Supplemental Table 4 , http://links.lww.com/CCM/H371). Notably, 70 (67%) of the included studies were published in only four journals ( Critical Care Medicine , Journal of Critical Care , Journal of Intensive Care , and Neurocritical Care ).…”

Section: Resultsmentioning

confidence: 99%

Defining Intensivists: A Retrospective Analysis of the Published Studies in the United States, 2010–2020*

Halpern,

Tan,

Bothwell

et al. 2024

Critical Care Medicine

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OBJECTIVES: The Society of Critical Care Medicine last published an intensivist definition in 1992. Subsequently, there have been many publications relating to intensivists. Our purpose is to assess how contemporary studies define intensivist physicians. DESIGN: Systematic search of PubMed, Embase, and Web of Science (2010–2020) for publication titles with the terms intensivist, and critical care or intensive care physician, specialist, or consultant. We included studies focusing on adult U.S. intensivists and excluded non–data-driven reports, non-U.S. publications, and pediatric or neonatal ICU reports. We aggregated the study title intensivist nomenclatures and parsed Introduction and Method sections to discern the text used to define intensivists. Fourteen parameters were found and grouped into five definitional categories: A) No definition, B) Background training and certification, C) Works in ICU, D) Staffing, and E) Database related. Each study was re-evaluated against these parameters and grouped into three definitional classes (single, multiple, or no definition). The prevalence of each parameter is compared between groups using Fisher exact test. SETTING: U.S. adult ICUs and databases. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of 657 studies, 105 (16%) met inclusion criteria. Within the study titles, 17 phrases were used to describe an intensivist; these were categorized as intensivist in 61 titles (58%), specialty intensivist in 30 titles (29%), and ICU/critical care physician in 14 titles (13%). Thirty-one studies (30%) used a single parameter (B–E) as their definition, 63 studies (60%) used more than one parameter (B–E) as their definition, and 11 studies (10%) had no definition (A). The most common parameter “Works in ICU” (C) in 52 studies (50%) was more likely to be used in conjunction with other parameters rather than as a standalone parameter (multiple parameters vs single-parameter studies; 73% vs 17%; p < 0.0001). CONCLUSIONS: There was no consistency of intensivist nomenclature or definitions in contemporary adult intensivist studies in the United States.

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Section: Resultsmentioning

confidence: 99%

Defining Intensivists: A Retrospective Analysis of the Published Studies in the United States, 2010–2020*

Halpern,

Tan,

Bothwell

et al. 2024

Critical Care Medicine

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“…9 Three studies showed early involvement of intensivists decreased mechanical ventilation times in post-operative cardiac patients. [8][9][10] Four studies reported that standardized ventilator weaning protocols are effective at decreasing mechanical ventilation times as well as improving outcomes. 3,9,11 In a prospective study, Fitch et al showed that patients were more likely to be extubated in less than six hours when a standardized weaning protocol was used (odds ratio = 2.39).…”

Section: Discussionmentioning

confidence: 99%

Intensivist -Driven Ventilator Management Shortens Duration of Mechanical Ventilation in Coronary Artery Bypass Graft Surgery Patients

Dollin

Elliott

Markert

et al. 2022

J Intensive Care Med

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Background Prolonged mechanical ventilation in post Coronary Artery Bypass Graft Surgery (CABG) is associated with deleterious effects including, increased ICU and hospital length of stay (LOS), infectious complications, and mortality. Standardized ventilator weaning protocols and the utilization of critical care physicians in post CABG patient care vary substantially among institutions. The purpose of this study was to evaluate if intensivist consultation in conjunction with a multidisciplinary, standardized ventilator weaning protocol improves outcomes in CABG patients. Materials and Methods We performed a single-center, retrospective, before-after cohort analysis at Miami Valley Hospital in Dayton, OH, a 970-bed community hospital. Patients were divided into two arms: the before cohort or delayed-consult group (critical care consult after six hours on ventilator) and after cohort or immediate-consult group (immediate critical care consult). All patients were weaned from ventilator using a standardized weaning protocol. Results A total of 764 patients were enrolled, 411 in the delayed-consult group and 353 in the immediate-consult group. The immediate-consult group had less time on initial mechanical ventilation than the delayed-consult group (5.86 ± 4.75 h vs. 6.00 ± 6.64 h, P = 0.038). The small advantages to immediate critical care consultation for higher percent of early extubations, fewer re-intubations, shorter ICU LOS, and lower rate of ICU readmission were not statistically significant. The two groups had similar ventilator free days, prolonged mechanical ventilation, hospital LOS, and in-hospital mortality. Conclusion Our study suggests that intensivist-driven ventilator management in conjunction with a multidisciplinary standardized weaning protocol shortens duration of mechanical ventilation in coronary artery bypass graft surgery patients.

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“…Even after years of growth, intensivists were only utilized in less than a third of the facilities that met our criteria in 2017. If the evidence continues to point toward an association between the use of intensivists and improved quality and lower costs (Gershengorn et al, 2017; Love et al, 2016; Na et al, 2016; Oh et al, 2019; Pronovost et al, 2004; Song et al, 2019; Sultan et al, 2018), administrators should actively explore strategies to utilize intensivists in their hospital ICUs. The results of our analysis suggest administrators of facilities that are located in lower resource environments, in particular, may need to engage with policymakers and payors to provide financial incentives for hospitals to utilize intensivists.…”

Section: Practice Implicationsmentioning

confidence: 99%

“…When deciding how to best deliver ICU medical care, hospital administrators can make a strategic choice to utilize intensivists rather than relying solely on referring and attending physicians. Although there are nontrivial incremental costs associated with staffing an ICU with intensivists (Nizamuddin & Tung, 2019), studies have shown that the use of intensivists is associated with lower mortality rates (Gershengorn et al, 2017; Song et al, 2019), decreased length of stay (Song et al, 2019; Tanios et al, 2020), improved patient outcomes (Na et al, 2016; Oh et al, 2019; Song et al, 2019; Sultan et al, 2018), and decreased costs (Love et al, 2016; Pronovost et al, 2004). In addition, the use of intensivists has been associated with improved ICU bed utilization and efficiency (Rodricks et al, 2015), which can lead to increased throughput and improved revenues for a facility.…”

mentioning

confidence: 99%

The organizational and environmental characteristics associated with hospitals’ use of intensivists

Liddle

Weech‐Maldonado

Davlyatov

et al. 2021

Health Care Manage Rev

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BackgroundAs large numbers of coronavirus disease 2019 (COVID-19) patients were admitted to intensive care units (ICUs) in 2020 and 2021, the United States faced a shortage of critical care providers. Intensivists are physicians specializing in providing care in the ICU. Although studies have explored the clinical and financial benefits associated with the use of intensivists, little is known about the organizational and market factors associated with a hospital administrator’s strategic decision to use intensivists.PurposeThe aim of this study was to use the resource dependence theory to better understand the organizational and market factors associated with a hospital administrator’s decision to use intensivists.MethodologyThe sample consisted of the national acute care hospitals (N = 4,986) for the period 2007–2017. The dependent variable was the number of full-time equivalent intensivists staffed in hospitals. The independent variables were organizational and market-level factors. A negative binomial regression model with state and year fixed effects, clustered at the hospital level, was used to examine the relationship between the use of intensivists and organizational and market factors.ResultsThe results from the analyses show that administrators of larger, not-for-profit hospitals that operate in competitive urban markets with relatively high levels of munificence are more likely to utilize intensivists.Practice ImplicationsWhen significant strains are placed on ICUs like what was experienced during the COVID-19 pandemic, it is imperative that hospital administrators understand how to best staff their ICUs. With a better understanding of the organizational and market factors associated with the use of intensivists, practitioners and policymakers alike can better understand how to strategically utilize intensivists in the ICU, especially in the face of a continuing pandemic.

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Improved Outcomes With Integrated Intensivist Consultation for Cardiac Surgery Patients

Cited by 6 publications

References 25 publications

Defining Intensivists: A Retrospective Analysis of the Published Studies in the United States, 2010–2020*

Defining Intensivists: A Retrospective Analysis of the Published Studies in the United States, 2010–2020*

Intensivist -Driven Ventilator Management Shortens Duration of Mechanical Ventilation in Coronary Artery Bypass Graft Surgery Patients

The organizational and environmental characteristics associated with hospitals’ use of intensivists

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