Differences in outcomes between ICU attending and senior resident physician led medical emergency team responses

Abstract

Introduction Although rapid response systems (RRS) have been shown to decrease the incidence of cardiac arrest (CA), there are no studies evaluating optimal staffing. We hypothesize that there are no outcome differences between ICU physician and senior resident led events. Methods A retrospective study of the RRS database at a single, academic hospital was performed from July 1, 2006 to May 31, 2010. Surgical patients and those in the ICU were excluded. Daytime (D) was defined as 7 am–5 pm Monday through Friday, and weekends were defined as 5 pm on Friday to 6:59 am on Monday. The nurse to patient ratio is constant during all shifts. An ICU physician leads daytime events on weekdays whereas night/weekend (NW) events are led by residents. NW events were compared against D events using chi square or Fischer’s exact test. Significance was defined as p < 0.05. Results A total of 1404 events were reviewed with 534 (38%) D and 870 (62%) NW events. Respiratory and staff concerns were more likely during NW compared to D (50% vs. 39% and 46% vs. 34%, p < 0.001, respectively). Following RRS activation, no difference was noted between D and NW periods in the incidence of progression to CA, transfer to ICU, or hospital mortality. Invasive procedures were more common in the NW period. Conclusion Resident-led RRS may have similar outcomes to attending intensivist led events. Prospective studies are needed to determine the ideal team composition.

Rapid response team: what factors interfere with its performance

“…(13)(14)(15)(16)(17) The teams were mostly composed of doctors, nurses, and physical therapists with experience and/ or specialization in critical care. (13)(14)(15)(16)(17)(18)(19)(20) Some studies included a pharmacist, laboratory technicians, radiology technicians, and administrators and clinical secretaries. (13,(16)(17)(18)20) It was shown that the presence of a resident doctor in the team represented no difference when compared with the responsible intensivist.…”

“…(13)(14)(15)(16)(17)(18)(19)(20) Some studies included a pharmacist, laboratory technicians, radiology technicians, and administrators and clinical secretaries. (13,(16)(17)(18)20) It was shown that the presence of a resident doctor in the team represented no difference when compared with the responsible intensivist. (16) Capacity building and maturation of the teams can improve the outcomes, reducing mortality and unplanned ICU admissions as well as enabling shorter activation time for efferent teams.…”

“…(13,(16)(17)(18)20) It was shown that the presence of a resident doctor in the team represented no difference when compared with the responsible intensivist. (16) Capacity building and maturation of the teams can improve the outcomes, reducing mortality and unplanned ICU admissions as well as enabling shorter activation time for efferent teams. (18)(19)(20)(21) Use of enabling tools for RRT.…”

“…et al / 2012 / United States. (16) Evaluate the differences between the RRT led by a resident physician or intensivist physician.…”

The association of intensivists with failure-to-rescue rates in outlier hospitals: Results of a national survey of intensive care unit organizational characteristics

“…Many of our staffing variables such as board certification and participation in daily care plans are components of the Leapfrog ICU staffing criteria [34]. Prior research on RRTs and ICU care transitions suggest that RRT team composition [35,36] and ICU liaison nurses (defined as dedicated registered nurses [RNs] who aid in post-ICU care transitions) might impact patient outcomes [37]. Trauma center status has also been shown to impact FTR [31,38] and is reflective of patient case mix at a given hospital [39].…”