On-site Physician Staffing in a Community Hospital Intensive Care Unit
Impact on Test and Procedure Use and on Patient Outcome
- Theodore C. M. Li, MD;
- Malcolm C. Phillips, MD;
- Linda Shaw, MPH;
- E. Francis Cook, ScD;
- Charles Natanson, MD;
- Lee Goldman, MD, MPH
- From the Departments of Medicine, St Barnabas Hospital, Bronx, NY (Dr Phillips and Natanson and Ms Shaw); Brigham and Women's Hospital, Boston (Drs Li, Cook, and Goldman); Cornell University Medical College, New York (Dr Phillips); and Harvard Medical School, Boston (Drs Li and Goldman). Dr Natanson is now with the Critical Care Medicine Department, National Institutes of Health, Bethesda, Md. Ms Shaw is now with Mt Sinai Medical Center, New York.
Abstract
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<.0001) and arterial catheters (9% v0%, P<.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).
(JAMA 1984;252:2023-2027)
Footnotes
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Reprint requests to Division of Internal Medicine, Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (Dr Li).
