Staffing model has little effect on ICU patient outcomes
MedWire News: Mortality risk and length of stay (LOS) among patients admitted to intensive care units (ICUs) remain similar whether care is delivered by an intensivist- or by a hospitalist-led team, US researchers report.
"We propose that hospitalists can provide quality care for lower acuity critical care patients," remark the research team, led by Kristin Wise (Emory University Hospital Midtown, Atlanta, Georgia).
They add: "This may improve intensivist availability to higher acuity critically ill patients and allow for judicious utilization of the limited intensivist supply."
As reported in the Journal of Hospital Medicine, the researchers assessed the outcomes of patients with a mean age of 61 years, who were admitted to ICUs and cared for by a hospitalist team (n=828) or an intensivist-led team (n=528). All patients were followed-up until death or hospital discharge.
In all, 168 (12.4%) patients died during the follow-up period. Of those deaths, 135 occurred in the ICU. Surviving patients had a mean LOS of 9 days.
After adjustment for disease severity, no significant difference in risk for ICU and in-hospital mortality, and LOS was found between patients cared for by hospitalists and those cared for by intensivists.
Specifically, patients with a hospitalist care team had a nonsignificant odds ratio of 0.8 for in-hospital and ICU mortality compared with intensivist-based care. And mean hospital LOS differed between the groups by less than 1 day.
Wise and team highlight that the use of respiratory support varied significantly between the two groups, with such support used by 11% and 52% of the hospitalist and intensivist care groups, respectively.
When the results were adjusted to accommodate the effect of mechanical ventilation use, disease severity showed association with LOS and mortality.
Of note, disease severity was determined by simplified acute physiology score (SAPS), where a score of less than 33 was equivalent to low disease severity, 34-51 equivalent to intermediate severity, and a score of 52 or greater reflected high disease severity.
Mechanically ventilated patients with intermediate illness severity treated by an intensivist-led team had significantly shorter hospital and ICU LOS than those treated by a hospitalist-led team, at 10.6 versus 17.8 days and 7.2 versus 10.6 days, respectively.
Similarly, patients cared for by an intensivist-led team had a lower in-hospital mortality rate than patients with a hospitalist team, at 15.6% versus 27.5%.
In light of these findings, Wise and team say that "future studies may better delineate specific subgroups of critically ill patients who benefit most from intensivist primary involvement."
They conclude: "Hospitalists may be instrumental in the critical care staffing shortage; however, identification of their ideal role requires further study."
By Lauretta Ihonor