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The Association Between Visiting Intensivists and ICU Outcomes
Tony Whitehouse1, James Hodson, Philip Pemberton
11Department of Critical Care and Anaesthesia, University Hospital Birmingham, Edgbaston, Birmingham, United Kingdom. 2University Department of Anaesthesia & Critical Care, Institute of Clinical Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom. 3Sunnybrook Health Sciences Centre and Interdepartmental Division of Critical Care, University of Toronto, ON, Canada.
Critical Care Medicine
|April 12, 2017
Summary
Intensivists unfamiliar with an intensive care unit (ICU) team and context were associated with higher patient mortality. This effect was significant in specific ICUs, suggesting practice variations impact outcomes.
Area of Science:
- Critical Care Medicine
- Healthcare Management
- Patient Safety
Background:
- Intensivist familiarity with intensive care unit (ICU) teams and specific hospital contexts may influence patient outcomes.
- Understanding the impact of intensivist rotation on patient care is crucial for optimizing ICU performance and safety.
Purpose of the Study:
- To investigate whether intensivists working in unfamiliar intensive care units (ICUs) impact patient mortality compared to those working in their routine ICUs.
- To identify if specific ICUs show a greater effect of intensivist unfamiliarity on patient outcomes.
Main Methods:
- A 5-year natural experimental crossover study in four UK teaching hospital ICUs.
- Compared patient outcomes (mortality) between 'home' intensivists (familiar with the ICU) and 'visitor' intensivists (unfamiliar with the ICU).
- Analyzed 9,981 admissions, controlling for patient demographics, Sequential Organ Failure Assessment (SOFA) scores, and admission types.
Main Results:
- 34.5% of patients were admitted by visitor intensivists, who managed patients with higher SOFA scores.
- Overall ICU mortality was not significantly higher for visitor intensivists (11.5% vs 10.2%, p=0.052).
- Multivariable analysis revealed significantly higher overall mortality for visitors (OR, 1.18; p=0.024), with significant effects in two specific ICUs.
Conclusions:
- Intensivist unfamiliarity with an ICU team and context was associated with increased patient mortality in certain ICUs.
- The precise reasons for this association remain unclear, potentially involving intensivist practices or team interactions.
- Findings highlight the importance of intensivist continuity and familiarity for maintaining patient safety and outcomes in ICUs.