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

Abstract

IntroductionResearch has demonstrated that intensivist-led care of the critically ill is associated with reduced intensive care unit (ICU) and hospital mortality. The objective of this study was to evaluate whether a relation exists between intensivist cover pattern (for example, number of days of continuous cover) and patient outcomes among adult general ICUs in England.MethodsWe conducted a retrospective cohort study by using data from a pooled case mix and outcome database of adult general critical care units participating in the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme. Consecutive admissions to participating units for the years 2010 to 2011 were linked to a survey of intensivist cover practices. Our primary outcome of interest was mortality at ultimate discharge from acute-care hospital.ResultsThe analysis included 80,122 patients admitted to 130 ICUs in 128 hospitals. Multivariable logistic regression analysis was used to assess the relation between intensivist cover patterns (days of continuous cover, grade of physician staffing at nighttime, and frequency of daily handovers) and acute hospital mortality, adjusting for patient case mix. No relation was seen between days of continuous cover by a single intensivist or grade of physician staffing at nighttime and acute hospital mortality. Acute hospital mortality and ICU length of stay were not associated with intensivist characteristics, intensivist full-time equivalents per bed, or years of clinical experience. Intensivist participation in handover was associated with increased mortality (odds ratio, 1.27; 95% confidence interval, 1.04 to 1.55); however, only nine units reported no intensivist participation.ConclusionsWe found no relation between days of continuous cover by a single intensivist or grade of physician staffing at nighttime and patient outcomes in adult, general ICUs in England. Intensivist participation in handover was associated with increased mortality; further research to confirm or refute this finding is required.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0491-3) contains supplementary material, which is available to authorized users.

Association of Intensive Care Unit Patient-to-Intensivist Ratios With Hospital Mortality

“…We used answers to 2 different questions, 1 from each staffing survey. The first was the United Kingdom Consultant Cover Census study (UK-3Cs), 9 conducted in 2011, in which was asked "open vs closed ICU?" and the second was a single question survey to ICUs in the CMP, conducted in 2013, in which was asked, "On weekdays, during daytime hours, is 1 or more intensive care consultants responsible for all patients in the unit?"…”

“…We used answers to 2 different questions, 1 from each staffing survey. The first was the United Kingdom Consultant Cover Census study (UK-3Cs), conducted in 2011, in which was asked “open vs closed ICU?” and the second was a single question survey to ICUs in the CMP, conducted in 2013, in which was asked, “On weekdays, during daytime hours, is 1 or more intensive care consultants responsible for all patients in the unit?” Daytime hours were defined as 8:00 am to 3:59 pm purposely to include hours in which primary intensivists are most likely to be physically present in the ICU. The answers from both surveys were assumed to apply for the full duration of this study, when more than 1 intensivist was responsible for daytime weekday care of ICU patients, the exact number was queried.…”

Toward the Ideal Ratio of Patients to Intensivists

“…This allows their work to be distinguished from prior work which used number of ICU beds to reflect ICU census 5 or the average full-time equivalent (FTE) of the intensivists at the ICU to reflect the number of intensivists caring for the patient. 6 Gershengorn and colleagues 4 provide an impressive number of alternative approaches to measuring individual physician workload in their sensitivity analyses, and find a consistent general pattern.…”

Challenges experienced by health care professionals working in resource-poor intensive care settings in the Limpopo province of South Africa

“…Park et al (2014) acknowledged that although there are shortages of ICU doctors, they are needed to staff ICUs. Wilcox et al (2014) specified that according to the European Society of Intensive Care Medicine (ESICM) guidelines, ICUs require specialised ICU doctors preferably for 24 h per day.…”