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Association of house staff training with mortality in children with critical illness
Punkaj Gupta1, Xinyu Tang2, Mallikarjuna Rettiganti2
1Division of Pediatric Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Insights
Hospitals with residency programs showed lower intensive care unit (ICU) mortality rates in critically ill children. This suggests that medical training programs are associated with improved survival outcomes for pediatric patients.
Area of Science:
- Pediatric Critical Care Medicine
- Medical Education Research
- Healthcare Quality Improvement
Background:
- Hospitals with house staff training programs often manage more complex patient populations.
- Understanding the impact of training on patient outcomes is crucial for healthcare quality.
Purpose of the Study:
- To assess the relationship between house staff training programs and mortality rates in critically ill children.
- To determine if pediatric intensive care unit (PICU) mortality differs between hospitals with and without residency/fellowship programs.
Main Methods:
- Analysis of the Virtual PICU Systems (VPS) database (2009-2013) including 336,335 pediatric patients from 108 centers.
- Comparison of mortality rates between hospitals with residency/fellowship programs and those without.
- Multivariable logistic regression models were used to adjust for patient severity and case-mix.
Main Results:
- Hospitals with training programs cared for patients with higher illness severity and greater risk of death.
- Despite managing more complex cases, hospitals with training programs demonstrated lower odds of intensive care unit (ICU) mortality.
- Adjusted survival rates were improved in pediatric intensive care units (PICUs) within hospitals with training programs.
Conclusions:
- Intensive care unit (ICU) care in hospitals with house staff training is linked to better survival rates in critically ill children.
- Medical training programs in pediatric critical care are associated with improved patient outcomes.
- These findings support the value of training programs in enhancing the quality of pediatric intensive care.
Aim:
To evaluate the association of house staff training with mortality in children with critical illness.
Methods:
Patients <18 years of age in the Virtual PICU Systems (VPS, LLC) Database (2009-2013) were included. The study population was divided in two study groups: hospitals with residency programme only and hospitals with both residency and fellowship programme. Control group constituted hospitals with no residency or fellowship programme. The primary study outcome was mortality before intensive care unit (ICU) discharge. Multivariable logistic regression models were fitted to evaluate association of training programmes with ICU mortality.
Results:
A total of 336 335 patients from 108 centres were included. Case-mix of patients among the hospitals with training programmes was complex; patients cared for in the hospitals with training programmes had greater severity of illness, had higher resource utilisation and had higher overall admission risk of death compared to patients cared for in the control hospitals. Despite caring for more complex and sicker patients, the hospitals with training programmes were associated with lower odds of ICU mortality.
Conclusion:
Our study establishes that ICU care provided in hospitals with training programmes is associated with improved adjusted survival rates among the Virtual PICU database hospitals in the United States.
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