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Physician team management affects goal achievement in the intensive care unit
David C Stockwell1, Anthony D Slonim, Murray M Pollack
1Children's National Medical Center, George Washington University School of Medicine, Washington, DC, USA. dstockwe@cnmc.org
Insights
Physician leadership skills significantly impact patient care efficiency. Higher management and leadership scores among intensivists correlated with better daily patient goal accomplishment, showing measurable differences in performance.
Area of Science:
- Medical Leadership
- Intensive Care Medicine
- Patient Care Quality
Background:
- Limited research exists on the impact of physician management and leadership skills on patient care outcomes.
- Assessing these skills in intensivists is crucial for improving care processes.
Purpose of the Study:
- To evaluate perceived differences in management and leadership performance among pediatric intensivists.
- To correlate these performance differences with patient care process outcomes.
Main Methods:
- A prospective cohort study was conducted in a pediatric intensive care unit.
- Residents and fellows assessed attending intensivists' performance using the Physician Management Index.
- Daily patient goal accomplishment was the primary outcome measure.
Main Results:
- Significant differences in Physician Management Index scores were observed among intensivists (p < .001).
- Performance scores correlated with intensivist age and experience.
- Higher Physician Management Index scores were associated with greater accomplishment of daily patient goals (r = 0.306, p < .001).
Conclusions:
- Physician management and leadership performance in intensivists can be objectively measured.
- These skills are linked to care efficiency, as indicated by daily patient goal achievement.
- Variability in performance exists among attending intensivists.
Objective:
There are few investigations evaluating the impact of physician management and leadership skills on patient care. Our objective was to determine whether there were perceived differences in management and leadership performance within a group of intensivists and to correlate these differences with processes of care outcomes.
Design:
Prospective cohort from January 31 to June 30, 2005.
Setting:
Pediatric intensive care unit in an urban, academic children's hospital.
Participants:
Pediatric intensive care unit staff intensivists were the primary participants.
Interventions:
None.
Measurements And Main Results:
The intensivists' management and leadership performances were assessed by residents and fellows using the Physician Management Index. The primary outcome attributable to the staff was the accomplishment of daily patient goals. A total of 827 resident and fellow assessments of the management and leadership performance of attendings (n = 8) were collected over 2077 patient days (103.4 +/- 39.0 surveys/attending). The mean Physician Management Index was 78.1 +/- 6.2 and differed significantly among the attendings (p < .001). There was excellent agreement by the raters concerning attending performance (intraclass correlation = 0.801). The attendings' Physician Management Indexes were correlated with age (r = 0.594, p < .001) and experience (r = 0.656, p < .001) but not other personal or environmental factors. An average of 3.3 +/- 0.6 goals per patient were written each day, and 86.0% +/- 7.0% were accomplished. Accomplishment of patient goals was correlated with the Physician Management Index (r = 0.306, p < .001) and length of rounds (r = -0.341, p < .001). Other variables, including midnight census, numbers of admissions and discharges, codes, and consultations, did not correlate with the Physician Management Index.
Conclusions:
Management and leadership performance of attending intensivists can be measured and is associated with efficiency of care as assessed by accomplishment of daily patient goals. Attendings differ in their management and leadership performances.
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