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Two Weeks Versus One Week of Maximal Patient-Intensivist Continuity for Adult Medical Intensive Care Patients: A
Andrew J Admon1,2,3,4, Shirley Cohen-Mekelburg3,5,6, Megan Opatrny7
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
Critical Care Medicine
|May 7, 2024
Summary
Extending intensivist care from one to two weeks showed no significant impact on patient outcomes in medical intensive care units (ICUs). This study suggests that longer patient-intensivist continuity does not necessarily improve mortality or length of stay.
Area of Science:
- Critical Care Medicine
- Health Services Research
Background:
- Optimal patient-intensivist continuity in intensive care units (ICUs) is crucial for patient outcomes.
- Intensivist scheduling models vary, impacting the duration of continuous care.
Purpose of the Study:
- To compare clinical outcomes between 2 weeks and 1 week of maximal patient-intensivist continuity in medical ICUs.
- To evaluate the association between extended continuity and mortality, length of stay, and mechanical ventilation duration.
Main Methods:
- Retrospective cohort study using target trial emulation in two U.S. urban teaching medical ICUs.
- Patients (≥18 years) admitted between March 2017 and February 2020 were analyzed.
- Inverse probability weighting and random-effects meta-analysis were used to adjust for baseline differences and estimate effects.
Main Results:
- No significant differences were observed in hospital mortality (OR, 1.01) or ICU length of stay (-0.25 d) between 2-week and 1-week continuity groups.
- For mechanically ventilated patients, adjusted mortality (OR, 1.00), ICU length of stay (+0.06 d), and ventilation duration (+0.37 d) also showed no significant differences.
- Exploratory outcomes such as imaging, echocardiogram, and consultation orders were also assessed.
Conclusions:
- Two weeks of maximal patient-intensivist continuity was not associated with improved clinical outcomes compared to 1 week in these medical ICUs.
- The findings suggest that extending intensivist continuity beyond one week may not confer additional benefits regarding key patient outcomes.
