On-site physician staffing in a community hospital intensive care unit. Impact on test and procedure use and on patient outcome

T. C. Li, M. C. Phillips, L. Shaw, E. F. Cook, C. Natanson and L. Goldman

To determine whether on-site physician staffing changed test and procedure use and improved patient outcome in a community hospital intensive care unit (ICU), we studied all ICU admissions for matched periods before and after the staffing change. Compared with the 463 year-1 patients, the 491 year-2 patients were no more likely to receive life-support interventions (respirators, dialysis, or pacemakers), but had substantially more monitoring interventions, such as pulmonary artery catheters (22% v 2%, P less than .0001) and arterial catheters (9% v 0%, P less than .0001). After controlling for factors that predicted death (age, mental status at time of admission, reason for ICU admission), year-2 patients were significantly more likely to survive the ICU and subsequent hospital stay (P = .01). Nearly all of the improvement of survival rate took place among patients with intermediate likelihoods of death; this improved survival rate persisted at the 12-month follow-up (P = .01).

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Association between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit
Levy et al.
ANN INTERN MED 2008;148:801-809.
ABSTRACT | FULL TEXT  

Effect of Intensive Care Unit Organizational Model and Structure on Outcomes in Patients with Acute Lung Injury
Treggiari et al.
Am. J. Respir. Crit. Care Med. 2007;176:685-690.
ABSTRACT | FULL TEXT  

The Effect of Lengthening Anesthesiology Residency on Subspecialty Education
Havidich et al.
Anesth. Analg. 2004;99:844-856.
ABSTRACT | FULL TEXT  

Physician Staffing Patterns and Clinical Outcomes in Critically Ill Patients: A Systematic Review
Pronovost et al.
JAMA 2002;288:2151-2162.
ABSTRACT | FULL TEXT  

Current Issues Affecting Critical Care Practice
Higgins
SEMIN CARDIOTHORAC VASC ANESTH 2002;6:279-284.
ABSTRACT  

The Hospitalist Movement 5 Years Later
Wachter and Goldman
JAMA 2002;287:487-494.
ABSTRACT | FULL TEXT  

Patient Characteristics and ICU Organizational Factors That Influence Frequency of Pulmonary Artery Catheterization
Rapoport et al.
JAMA 2000;283:2559-2567.
ABSTRACT | FULL TEXT  

Analytic Reviews : Impact of Intensivists and ICU Teams on Patient Outcomes: Hanson CW, Aranda M Impact of intensivists and ICU teams on patient outcomes J Intensive Care Med 1999,14 254-261
Hanson and Aranda
J Intensive Care Med 1999;14:254-261.
 

Outcomes Research in Critical Care . Results of the American Thoracic Society Critical Care Assembly Workshop on Outcomes Research
RUBENFELD et al.
Am. J. Respir. Crit. Care Med. 1999;160:358-367.
FULL TEXT  

Organizational Characteristics of Intensive Care Units Related to Outcomes of Abdominal Aortic Surgery
Pronovost et al.
JAMA 1999;281:1310-1317.
ABSTRACT | FULL TEXT  

Community-Wide Assessment of Intensive Care Outcomes Using a Physiologically Based Prognostic Measure: Implications for Critical Care Delivery From Cleveland Health Quality Choice
Sirio et al.
Chest 1999;115:793-801.
ABSTRACT | FULL TEXT  

An Introduction to the Hospitalist Model
Wachter
ANN INTERN MED 1999;130:338-342.
ABSTRACT | FULL TEXT  

The Impact of Hospitalists on Medical Education and the Academic Health System
Goldman
ANN INTERN MED 1999;130:364-367.
ABSTRACT | FULL TEXT  

Introduction
Higgins
SEMIN CARDIOTHORAC VASC ANESTH 1998;2:1-3.
 

A "Closed" Medical Intensive Care Unit (MICU) Improves Resource Utilization When Compared with an "Open" MICU
MULTZ et al.
Am. J. Respir. Crit. Care Med. 1997;157:1468-1473.
ABSTRACT | FULL TEXT  

The Emerging Role of "Hospitalists" in the American Health Care System
Wachter and Goldman
NEJM 1996;335:514-517.
FULL TEXT  

Pathogenetic Mechanisms of Septic Shock
Parrillo
NEJM 1993;328:1471-1478.
FULL TEXT  

Sepsis
Wakeford and Hardin
Journal of Pharmacy Practice 1991;4:269-280.