The Effect of Introducing a Consultant Weekly Working Pattern on Mortality in a Critical Care Unit

Abstract

Previous publications have suggested that increasing the continuity of consultant working in critical care has a positive effect on patient outcomes. We introduced weekly day-time consultant working in a critical care unit and assessed the impact on mortality after one year. Two critical care units in separate district general hospitals in the same trust, with the same clinical management structure, treatment protocols and equipment, introduced changes in clinical practice at the same time during the study period. Unit one introduced a consultant work pattern of weekly working. Unit two retained the previous pattern of half-day or single full-day consultant working and acted as a control group. The mortality of all admissions and of a subgroup of ventilated admissions were compared for the year before and a year after this change. The mortality of all admissions showed a reduction in both units but this did not achieve statistical significance. The mortality of ventilated admissions in unit one showed a statistically significant reduction. There was a smaller reduction in unit two that was not statistically significant. Consultant weekly working was associated with a reduction in mortality of ventilated admissions to a general critical care unit.

Comparing mortality among adult, general intensive care units in England with varying intensivist cover patterns: a retrospective cohort study

“…In a 1999 report by the UK Audit Commission, higher-than-expected acute hospital mortality was reported for ICUs with sessional allocation, where an intensivist worked a set number of sessions each week (for example, every Tuesday morning), compared with those with weekly allocation, in which an intensivist worked in the ICU for a week [ 6 ]. This finding was subsequently supported by other observational studies [ 7 , 8 ]. It was hypothesized that weekly cover might improve continuity of care (intensivists are likely to have an improved overall knowledge of a patient’s condition), allow more-timely treatment (more time available to conduct treatment/procedures rather than defer them to the next session), and facilitate communication (less information lost in handovers) [ 8 ].…”

“…This finding was subsequently supported by other observational studies [7,8]. It was hypothesized that weekly cover might improve continuity of care (intensivists are likely to have an improved overall knowledge of a patient’s condition), allow more-timely treatment (more time available to conduct treatment/procedures rather than defer them to the next session), and facilitate communication (less information lost in handovers) [8].…”

Comparing mortality among adult, general intensive care units in England with varying intensivist cover patterns: a retrospective cohort study

“…In a 1999 report by the UK Audit Commission, higherthan-expected acute hospital mortality was reported for ICUs with sessional allocation, where an intensivist worked a set number of sessions each week (for example, every Tuesday morning), compared with those with weekly allocation, in which an intensivist worked in the ICU for a week [6]. This finding was subsequently supported by other observational studies [7,8]. It was hypothesized that weekly cover might improve continuity of care (intensivists are likely to have an improved overall knowledge of a patient's condition), allow more-timely treatment (more time available to conduct treatment/procedures rather than defer them to the next session), and facilitate communication (less information lost in handovers) [8].…”