Intensivists improve outcomes and compliance with process measures in critically ill patients

Uroghupatei P. Iyegha, Javariah I. Asghar, Elizabeth B. Habermann, Alain Broccard, Craig Weinert, Greg Beilman

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Background: Specialty-trained intensivist involvement in the care of critically ill patients has been associated with improved outcomes; however, the factors contributing to this observation are unknown. We hypothesized that intensivist-led ICU care would result in decreased mortality, length of stay, and rate of deep venous thrombosis/pulmonary embolism along with improved compliance with ICU process measures. Study Design: We performed a retrospective review of 847 patients using the October 2008 transition at a regional medical center from an open ICU to a model in which board-certified intensivists assume primary responsibility or co-management of all critically ill patients. Included in the analysis were patients admitted to the ICU during the 3 months immediately before the transition (June to September 2008) and a 3-month period 1 year later (June to September 2009). End points included mortality, length of stay, and deep venous thrombosis/pulmonary embolism rates, as well as several ICU process measures. Results: Patients in the post-intensivist cohort had a shorter hospital length of stay (7.4 days vs 8.7 days; p = 0.009) and a trend toward decreased mortality (9.3% vs 13.3%; p = 0.086). Patients also received timely initiation of deep venous thrombosis prophylaxis more frequently and tended toward more frequent timely initiation of nutritional support. Patients in the post-intensivist cohort admitted to the ICU with sepsis demonstrated a significant decrease in mortality (11.4% vs 35.0%, p = 0.010), both overall and in patients with APACHE II scores >20. Conclusions: Intensivist-led ICU care is associated with improved outcomes in patients with sepsis and possibly in all ICU patients. Compliance with selected evidence-based practices improved. Additional study is needed to understand the mechanisms by which the intensivist model improves outcomes.

Original languageEnglish (US)
Pages (from-to)363-372
Number of pages10
JournalJournal of the American College of Surgeons
Volume216
Issue number3
DOIs
StatePublished - Mar 1 2013

Keywords

  • DVT
  • GI
  • LOS
  • PE
  • deep vein thrombosis
  • gastrointestinal
  • length of stay
  • pulmonary embolism

ASJC Scopus subject areas

  • Surgery

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