Can the experienced ICU physician predict ICU length of stay and outcome better than less experienced colleagues?

Vicente, Fábio Gusmão; Lomar, Frederico Polito; Mélot, Christian; Vincent, Jean‐Louis

doi:10.1007/s00134-003-2139-7

Cited by 39 publications

(12 citation statements)

References 24 publications

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“…Physician’s expertise, as assessed in this study, was not associated with predictive ability. Although it seems intuitive that higher expertise would lead to higher accuracy, clinicians’ prognostication is highly variable4 and the literature is not consensual in this subject, with varying results being reported 6 7…”

Section: Discussionmentioning

confidence: 99%

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Prognostication in urgent intensive care unit referrals: a cohort study

Ramos

Dias

Passos

et al. 2018

BMJ Support Palliat Care

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Section: Discussionmentioning

confidence: 99%

“…However, there is little research on the ability of physicians to predict which patients would benefit from intensive care 4. There is great variability in those predictions4 and non-clinical features may affect judgement,5 which has raised concern about biases, self-fulfilling prophecies4 6–9 and potentially inappropriate care 10…”

Section: Introductionmentioning

confidence: 99%

Prognostication in urgent intensive care unit referrals: a cohort study

Ramos

Dias

Passos

et al. 2018

BMJ Support Palliat Care

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“…[10, 15] One reason for this may be due to large differences in patient management approaches among ICUs. One Swiss study indicated that the use of discharge guidelines was limited and there was marked heterogeneity in discharge practices among 55 ICUs.…”

Section: Discussionmentioning

confidence: 99%

Modelling risk-adjusted variation in length of stay among Australian and New Zealand ICUs

et al. 2017

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PurposeComparisons between institutions of intensive care unit (ICU) length of stay (LOS) are significantly confounded by individual patient characteristics, and currently there is a paucity of methods available to calculate risk-adjusted metrics.MethodsWe extracted de-identified data from the Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database for admissions between January 1 2011 and December 31 2015. We used a mixed-effects log-normal regression model to predict LOS using patient and admission characteristics. We calculated a risk-adjusted LOS ratio (RALOSR) by dividing the geometric mean observed LOS by the exponent of the expected Ln-LOS for each site and year. The RALOSR is scaled such that values <1 indicate a LOS shorter than expected, while values >1 indicate a LOS longer than expected. Secondary mixed effects regression modelling was used to assess the stability of the estimate in units over time.ResultsDuring the study there were a total of 662,525 admissions to 168 units (median annual admissions = 767, IQR:426–1121). The mean observed LOS was 3.21 days (median = 1.79 IQR = 0.92–3.52) over the entire period, and declined on average 1.97 hours per year (95%CI:1.76–2.18) from 2011 to 2015. The RALOSR varied considerably between units, ranging from 0.35 to 2.34 indicating large differences after accounting for case-mix.ConclusionsThere are large disparities in risk-adjusted LOS among Australian and New Zealand ICUs which may reflect differences in resource utilization.

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“…Predicting the duration of mechanical ventilation and ICU stay can be difficult and the use of long-acting sedatives/analgesics in the early phase of ICU admission can prolong the duration of mechanical ventilation when a patient recovers more quickly than expected [10]. In such unpredictable circumstances, a short-acting agent may improve the speed of weaning from the ventilator and advance ICU discharge.…”

Section: Introductionmentioning

confidence: 99%

Cost-consequence analysis of remifentanil-based analgo-sedation vs. conventional analgesia and sedation for patients on mechanical ventilation in the Netherlands

Hakkaart

Tan

et al. 2010

Crit Care

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IntroductionHospitals are increasingly forced to consider the economics of technology use. We estimated the incremental cost-consequences of remifentanil-based analgo-sedation (RS) vs. conventional analgesia and sedation (CS) in patients requiring mechanical ventilation (MV) in the intensive care unit (ICU), using a modelling approach.MethodsA Markov model was developed to describe patient flow in the ICU. The hourly probabilities to move from one state to another were derived from UltiSAFE, a Dutch clinical study involving ICU patients with an expected MV-time of two to three days requiring analgesia and sedation. Study medication was either: CS (morphine or fentanyl combined with propofol, midazolam or lorazepam) or: RS (remifentanil, combined with propofol when required). Study drug costs were derived from the trial, whereas all other ICU costs were estimated separately in a Dutch micro-costing study. All costs were measured from the hospital perspective (price level of 2006). Patients were followed in the model for 28 days. We also studied the sub-population where weaning had started within 72 hours.ResultsThe average total 28-day costs were €15,626 with RS versus €17,100 with CS, meaning a difference in costs of €1474 (95% CI -2163, 5110). The average length-of-stay (LOS) in the ICU was 7.6 days in the RS group versus 8.5 days in the CS group (difference 1.0, 95% CI -0.7, 2.6), while the average MV time was 5.0 days for RS versus 6.0 days for CS. Similar differences were found in the subgroup analysis.ConclusionsCompared to CS, RS significantly decreases the overall costs in the ICU.Trial RegistrationClinicaltrials.gov NCT00158873.

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Can the experienced ICU physician predict ICU length of stay and outcome better than less experienced colleagues?

Cited by 39 publications

References 24 publications

Prognostication in urgent intensive care unit referrals: a cohort study

Prognostication in urgent intensive care unit referrals: a cohort study

Modelling risk-adjusted variation in length of stay among Australian and New Zealand ICUs

Cost-consequence analysis of remifentanil-based analgo-sedation vs. conventional analgesia and sedation for patients on mechanical ventilation in the Netherlands

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