Faculty Collaboration Database

Implementation of 24/7 intensivist presence in the SICU: effect on processes of care. J Trauma Acute Care Surg 2013 Feb;74(2):563-7

Date

01/29/2013

Pubmed ID

23354251

DOI

10.1097/TA.0b013e31827880a8

Scopus ID

2-s2.0-84875255364 (requires institutional sign-in at Scopus site)   20 Citations

Abstract

BACKGROUND: Staffing of attending intensivists 24 hours per day, 7 days per week (24/7) in the surgical intensive care unit (SICU) has unknown benefits. We hypothesized that 24/7 attending intensivist staffing in the SICU would improve outcomes and processes of care.

METHODS: We retrospectively reviewed 26 months of admissions to our 20-bed SICU, comparing 13 months before and 13 months after addition of an in-house night intensivist to the existing day intensivist with a nighttime on-demand model. Primary outcomes were mortality, complications, SICU length of stay, and ventilator days. Secondary outcomes were use of intensivist-directed ancillary testing and therapies, as well as physician billing (relative value units per full-time equivalent [RVU/FTE]).

RESULTS: A total of 2,829 patients were included: 1,408 before and 1,421 after 24/7 staffing. Baseline characteristics, mortality, complications, ventilation days, ICU and hospital length of stay, and readmission rate were similar between groups (all p > 0.05). Use of blood products and imaging tests (computed tomographic scans) were significantly reduced. Total RVU increased, as did the RVU/FTE ratio.

CONCLUSION: Implementation of 24/7 staffing did not improve SICU morbidity or mortality but was associated with decreased blood product use and fewer axial imaging studies. The RVU/FTE ratio was improved. Overall health care value may be decreased under this model.

LEVEL OF EVIDENCE: Care management study, level IV.

Author List

van der Wilden GM, Schmidt U, Chang Y, Bittner EA, Cobb JP, Velmahos GC, Alam HB, de Moya MA, King DR

Author

Marc Anthony De Moya MD Chief, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Aged, 80 and over
Critical Care
Female
Hospital Mortality
Humans
Intensive Care Units
Length of Stay
Male
Middle Aged
Patient Readmission
Program Development
Respiration, Artificial
Retrospective Studies
Trauma Centers
Young Adult