ORIGINAL ARTICLE
Continuous Mandatory Onsite Consultant Intensivists in the ICU: Impacts on Patient Outcomes Salim Baharoon, MD,* Walid Alyafi, MD,Þ Hani Tamim, PhD,þ Hamdan Al-Jahdali, MD,* Eman Alsafi, MD,§ Abdullah Al-Sayyari, MD,|| and Qanta Ahmed, MD¶
Objective: The aim of this study was to compare the impacts on patient outcomes of continuous versus on-demand access to certified consultant intensivists in the intensive care unit (ICU). Methods: Two general adult ICUs within the same health-care organization were compared in terms of patient outcomes. One unit featured continuous mandatory presence of a consultant intensivist (unit A), whereas the other had continuous access to a consultant intensivist during daytime hours but only on-demand access during the night-time hours (unit B). The data collected from these 2 units over the same 12-month period included sex, age, APACHE II score, disease category (medical, surgical, or traumatic), ICU mortality, and length of stay. A subgroup analysis was undertaken to assess the impact of disease severity, age, sex, and disease category on mortality. Results: When adjusted for disease severity, mortality was significantly lower in unit A with continuous mandatory 24-hour presence of a consultant intensivist compared with unit B with on-demand access to a consultant intensivist after working hours. Old age, female sex, and a higher APACHE II score were associated with poorer outcomes at both sites. The subgroup analysis revealed that the difference in mortality was only significant among medical patients but not among surgical or trauma patients. Conclusions: An improved survival rate was observed only among medical patients admitted to the ICU with mandatory continuous access to a consultant intensivist, despite the presence of greater disease severity in the population admitted to this unit. Key Words: mandatory, intensivist, consultant ICU (J Patient Saf 2016;12: 108Y113)
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ritical care medicine is heavily resource intensive, accounting for 25% to 30% of all acute hospital costs.1Y3 These resources demand investment in technical, pharmacologic, and highly skilled manpower. There is substantial variability in the level of physician staffing across intensive care units worldwide.4,5 However, staffing is universally acknowledged as a critically important determinant of overall patient outcomes following intensive care unit (ICU) admission.5Y7 Although the rationale of access to full-time (24-hour) board certified consultant intensivists in the ICU is attractive, its From the *King Saud bin Abdulaziz University for Health Sciences, Riyadh; †King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia; ‡Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon; §Quality Management, King Saud Chest Specialty Hospital, Riyadh, Professor of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; ||Professor of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; and ¶Associate Professor, State University of New York, New York. Correspondence: Salim Baharoon, MD, King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, P.O. Box 22940, Riyadh 11426, Kingdom of Saudi Arabia (e
Continuous Mandatory Onsite Consultant Intensivists in the ICU: Impacts on Patient Outcomes Salim Baharoon, MD,* Walid Alyafi, MD,Þ Hani Tamim, PhD,þ Hamdan Al-Jahdali, MD,* Eman Alsafi, MD,§ Abdullah Al-Sayyari, MD,|| and Qanta Ahmed, MD¶
Objective: The aim of this study was to compare the impacts on patient outcomes of continuous versus on-demand access to certified consultant intensivists in the intensive care unit (ICU). Methods: Two general adult ICUs within the same health-care organization were compared in terms of patient outcomes. One unit featured continuous mandatory presence of a consultant intensivist (unit A), whereas the other had continuous access to a consultant intensivist during daytime hours but only on-demand access during the night-time hours (unit B). The data collected from these 2 units over the same 12-month period included sex, age, APACHE II score, disease category (medical, surgical, or traumatic), ICU mortality, and length of stay. A subgroup analysis was undertaken to assess the impact of disease severity, age, sex, and disease category on mortality. Results: When adjusted for disease severity, mortality was significantly lower in unit A with continuous mandatory 24-hour presence of a consultant intensivist compared with unit B with on-demand access to a consultant intensivist after working hours. Old age, female sex, and a higher APACHE II score were associated with poorer outcomes at both sites. The subgroup analysis revealed that the difference in mortality was only significant among medical patients but not among surgical or trauma patients. Conclusions: An improved survival rate was observed only among medical patients admitted to the ICU with mandatory continuous access to a consultant intensivist, despite the presence of greater disease severity in the population admitted to this unit. Key Words: mandatory, intensivist, consultant ICU (J Patient Saf 2016;12: 108Y113)
C
ritical care medicine is heavily resource intensive, accounting for 25% to 30% of all acute hospital costs.1Y3 These resources demand investment in technical, pharmacologic, and highly skilled manpower. There is substantial variability in the level of physician staffing across intensive care units worldwide.4,5 However, staffing is universally acknowledged as a critically important determinant of overall patient outcomes following intensive care unit (ICU) admission.5Y7 Although the rationale of access to full-time (24-hour) board certified consultant intensivists in the ICU is attractive, its From the *King Saud bin Abdulaziz University for Health Sciences, Riyadh; †King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia; ‡Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon; §Quality Management, King Saud Chest Specialty Hospital, Riyadh, Professor of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; ||Professor of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; and ¶Associate Professor, State University of New York, New York. Correspondence: Salim Baharoon, MD, King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, P.O. Box 22940, Riyadh 11426, Kingdom of Saudi Arabia (e
