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Higher surgical critical care staffing levels are associated with improved National Surgical Quality Improvement
Christopher R Reed1, Sandy L Fogel, Bryan R Collier
1From the Virginia Tech - Carilion School of Medicine, Roanoke, Virginia.
Background:
The changing face of American health care demands careful scrutiny of resource allocation. The impact of the surgical intensivist model on general surgical quality measures has not been studied. Our objective was to investigate the relationship between surgical critical care staffing and indicators of general surgical quality measured by the National Surgical Quality Improvement Program (NSQIP).
Methods:
We retrospectively examined the number of attending surgical intensivists at our tertiary care center biannually from January 2008 through June 2012. Risk-adjusted indicators of general surgical quality were captured and reported semiannually by NSQIP. Mortality, overall morbidity, patients on ventilator for more than 48 hours, unplanned intubations, and venous thromboembolism were included. Student's t test was used to compare the staffing levels and associated NSQIP odds ratios of a 3-year control period of full commitment with a 2-year period following significant provider attrition.
Results:
The number of full-time surgical intensivists ranged from 2 to 8, with a period of rapid decline in late 2010 to early 2011 followed by slow recovery. There was a mean of 6.6 surgical intensivists during the 3 years before the decline and a mean of 4 in the 2 years after the decline and recovery (p < 0.005). This period of decline was associated with a significant increase in the odds ratio of ventilation for more than 48 hours (before, 0.936; after, 1.87; p = 0.0086) and of venous thromboembolism (before, 0.844; after 1.43; p = 0.0268). A trend in increased unplanned intubations was also observed. Overall morbidity and mortality were not affected. Notably, quality indicators seemed to rapidly approach baseline levels as new surgical intensivists were recruited.
Conclusion:
Institutional commitment to recruitment and retention of a surgical critical care team leads to improved NSQIP general surgery quality measures.
Level Of Evidence:
Care management study, level IV.