Toward the Ideal Ratio of Patients to Intensivists

Viglianti, Elizabeth M.; Iwashyna, Theodore J.

doi:10.1001/jamainternmed.2016.8476

Cited by 7 publications

(3 citation statements)

References 9 publications

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“… 29 Although it is difficult to generalize the current ICU findings to other countries, this study showed that an optimal patient-to- intensivist ratio was associated with decreased in-hospital and ICU mortality rates. 29 30 Therefore, in addition to the presence of intensivists, achieving the optimal intensivist-to-patient ratio will decrease the in-hospital mortality rate.…”

Section: Discussionmentioning

confidence: 99%

Impact of Intensivist and Nursing Staff on Critically Ill Patient Mortality: A Retrospective Analysis of the Korean NHIS Cohort Data, 2011–2015

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Impact of Intensivist and Nursing Staff on Critically Ill Patient Mortality: A Retrospective Analysis of the Korean NHIS Cohort Data, 2011–2015

et al. 2021

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“…Most notably, it represents only one system. While the VA is nationwide, provides inpatient care comparable in quality to other U.S. systems [26], and has longer term outcomes similar to other U.S. systems [27], it is only one system. To reduce this limitation, we have harmonized to the standards of an existing binational database in the hopes of facilitating collaborative cross-system research.…”

Section: Discussionmentioning

confidence: 99%

Veterans Affairs patient database (VAPD 2014–2017): building nationwide granular data for clinical discovery

Wang¹,

Vincent²,

Wiitala³

et al. 2019

BMC Med Res Methodol

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Background To study patient physiology throughout a period of acute hospitalization, we sought to create accessible, standardized nationwide data at the level of the individual patient-facility-day. This methodology paper summarizes the development, organization, and characteristics of the Veterans Affairs Patient Database 2014–2017 (VAPD 2014–2017). The VAPD 2014–2017 contains acute hospitalizations from all parts of the nationwide VA healthcare system with daily physiology including clinical data (labs, vitals, medications, risk scores, etc.), intensive care unit (ICU) indicators, facility, patient, and hospitalization characteristics. Methods The VA data structure and database organization represents a complex multi-hospital system. We define a single-site hospitalization as one or more consecutive stays with an acute treating specialty at a single facility. The VAPD 2014–2017 is structured at the patient-facility-day level, where every patient-day in a hospital is a row with separate identification variables for facility, patient, and hospitalization. The VAPD 2014–2017 includes daily laboratory, vital signs, and inpatient medication. Such data were validated and verified through lab value range and comparison with patient charts. Sepsis, risk scores, and organ dysfunction definitions were standardized and calculated. Results We identified 565,242 single-site hospitalizations (SSHs) in 2014; 558,060 SSHs in 2015; 553,961 SSHs in 2016; and 550,236 SSHs in 2017 at 141 VA hospitals. The average length of stay was four days for all study years. In-hospital mortality decreased from 2014 to 2017 (1.7 to 1.4%), 30-day readmission rates increased from 15.3% in 2014 to 15.6% in 2017; 30-day mortality also decreased from 4.4% in 2014 to 4.1% in 2017. From 2014 to 2017, there were 107,512 (4.8%) of SSHs that met the Center for Disease Control and Prevention’s Electronic Health Record-based retrospective definition of sepsis. Conclusion The VAPD 2014–2017 represents a large, standardized collection of granular data from a heterogeneous nationwide healthcare system. It is also a direct resource for studying the evolution of inpatient physiology during both acute and critical illness. Electronic supplementary material The online version of this article (10.1186/s12874-019-0740-x) contains supplementary material, which is available to authorized users.

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“…Some researchers have reported results that re ect the diversity of pro ciency among ICU physicians and the extent of training in intensive care, and these need to be demonstrated by an appropriate approach [7,29]. As heterogeneity in ICU physicians has not been considered in most studies that have examined outcome variations in critically ill patients, the results potentially re ect the intensivist attribution and should be interpreted with caution when applying this study's ndings to ICU management policy.…”

Section: Discussionmentioning

confidence: 85%

Regional differences and mortality-associated risk factors among older patients with septic shock: Administrative data analysis with multilevel logistic regression modeling

Yoshida

Babazono

Liu

et al. 2022

Preprint

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Background Older patients with septic shock are generally difficult to treat, have poor outcomes because of frailty and vulnerability, and may be highly sensitive to the quality of clinical care. Therefore, differences in treatment that arise from variations in intensive care unit (ICU) policies and each physician may influence mortality. We hypothesized that regional variability exists in mortality among older patients with septic shock, and investigated mortality-associated factors. Methods Administrative medical claims data were analyzed; participants were enrolled from April 2015 to March 2020. In Japan, engagement of at least one ICU physician exclusively at the ICU is a mandatory requirement to claim governmental incentive. In this study, ICU physicians were differentiated as “intensivist” and “ICU-dedicated physician” based on whether they were board-certified or not, respectively, in intensive care medicine. The primary outcome was the 28-day mortality after ICU admission. Data from nine secondary medical areas with ICU facilities were analyzed. We calculated and compared the 28-day mortality by each area. To adjust for patient characteristics and hospital profiles, multilevel logistic regression analyses were conducted. Results Among our 1,238 participants, mortality varied from 18.3–41.4% across nine areas. Based on multilevel logistic analyses, the model including variables on patient characteristics and hospital profiles was best-fitted, and these variables did not vary significantly across the nine areas. Age group, post-surgical admission, and the number of ICU beds per intensivist were significantly associated with mortality. The adjusted odds ratio for the ratio of ICU beds to intensivist was 2.25 (95% CI [1.36–3.72], p < 0.01), compared with no intensivist versus one or more intensivists for four ICU beds. Conclusions Regional mortality variability of older patients with septic shock was ascertained through our analysis. Mortality may be influenced by whether the ICU physicians are board-certified in intensive care medicine. To ensure quality care of older patients with septic shock, standard criteria, similar to those applied to intensivists, should be considered and applied to ICU physicians.

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Toward the Ideal Ratio of Patients to Intensivists

Cited by 7 publications

References 9 publications

Impact of Intensivist and Nursing Staff on Critically Ill Patient Mortality: A Retrospective Analysis of the Korean NHIS Cohort Data, 2011–2015

Impact of Intensivist and Nursing Staff on Critically Ill Patient Mortality: A Retrospective Analysis of the Korean NHIS Cohort Data, 2011–2015

Veterans Affairs patient database (VAPD 2014–2017): building nationwide granular data for clinical discovery

Regional differences and mortality-associated risk factors among older patients with septic shock: Administrative data analysis with multilevel logistic regression modeling

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