Clinical impact of physician staffing transition in intensive care units: a retrospective observational study

Abstract

Background Intensivists play an essential role in improving the outcomes of critically ill patients in intensive care units (ICUs). The transition of ICU physician staffing from low-intensity ICUs (elective intensivist or no intensivist consultation) to high-intensity ICUs (mandatory intensivist consultation or a closed ICU) improves clinical outcomes. However, whether a transition from high-intensity to low-intensity ICU staffing affects ICU outcomes and quality of care remains unknown. Methods A retrospective observational study was conducted to examine the impact of high- versus low-intensity staffing models on all-cause mortality in a suburban secondary community hospital with 400 general beds and 8 ICU beds. The ICU was switched from a high-intensity staffing model (high-former period) to low-intensity staffing in July 2019 (low-mid period) and then back to high-intensity staffing in March 2020 (high-latter period). Patients admitted from the emergency department, general ward, or operating room after emergency surgery were enrolled in these three periods and compared, balancing the predicted mortality and covariates of the patients. The primary outcome was all-cause mortality analyzed using hazard ratios (HRs) from Cox proportional hazards regression. An interrupted time-series analysis (ITSA) was also conducted to evaluate the effects of events (level change) and time. Results There were 962 eligible admissions, of which 251, 213, and 498 occurred in the high-former, low-mid, and high-latter periods, respectively. In the matched group (n = 600), the all-cause mortality rate comparing the high-former period with the low-mid period showed an HR of 0.88 [95% confidence interval (CI), 0.56, 1.39; p = 0.58] and that comparing the high-latter period with the low-mid period showed an HR of 0.84 [95% CI, 0.54, 1.30; p = 0.43]. The result for comparison between the three periods was p = 0.80. ITSA showed level changes of 4.05% [95% CI, -13.1, 21.2; p = 0.63] when ICU staffing changed from the high-former to the low-mid period and 1.35% [95% CI, -13.8, 16.5; p = 0.86] when ICU staffing changed from the low-mid to the high-latter period. Conclusion There was no statistically significant difference in all-cause mortality among the three ICU staffing periods. This study suggests that low-intensity ICU staffing might not worsen clinical outcomes in the ICU in a medium-sized community hospital. Multiple factors, including the presence of an intensivist, other medical staff, and practical guidelines, influence the prognosis of critically ill patients.

The impact of pediatric intensivists on the management of severe pediatric diabetic ketoacidosis in pediatric intensive care units

“…The mixed results in several studies are due to other organizational factors such as primary care practices, multidisciplinary team support, nurse-led quality, and type of ICU, and all of these factors can affect PICU outcomes 13 . The existence of intensivists is not the sole factor in uencing ICU outcomes 2 . There are current published guidelines for DKA, and most experienced hospitals use protocolized treatment in patients with DKA.…”

“…Intensivists are crucial in managing intensive care units (ICUs) and providing high-quality intensive care 2 .…”

A Ten-Year Review of the Management of Medical Patients in the Intensive Care Unit in a Resource-Poor Setting in Southern Nigeria

“…The ICU requires properly trained staff and high staffto-patient ratios. 1,2,3,4 A large amount of personnel and material is needed to fund and run the ICU, 5,6 so only patients who meet the criteria for ICU admission should be admitted. 7 In Africa, running an ICU has been largely difficult because of a lack of funds and manpower.…”