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Organisational matters
Intensivist physician staffing and the process of care in academic medical centres
  1. Jeremy M Kahn1,
  2. Helga Brake2,
  3. Kenneth P Steinberg3
  1. 1Division of Pulmonary, Allergy and Critical Care Medicine, Center for Clinical Epidemiology and Biostatistics, and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2University Health System Consortium, Oak Brook, Illinois, USA
  3. 3Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington, USA
  1. Correspondence to:
 Dr Jeremy M Kahn
 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, 874 Maloney Building, 3600 Spruce Street, Philadelphia, Pennsylvania 19104, USA; jkahn{at}cceb.med.upenn.edu

Abstract

Background: Although intensivist physician staffing is associated with improved outcomes in critical care, little is known about the mechanism leading to this observation.

Objective: To determine the relationship between intensivist staffing and select process-based quality indicators in the intensive care unit.

Research design: Retrospective cohort study in 29 academic hospitals participating in the University HealthSystem Consortium Mechanically Ventilated Patient Bundle Benchmarking Project.

Patients: 861 adult patients receiving prolonged mechanical ventilation in an intensive care unit.

Results: Patient-level information on physician staffing and process-of-care quality indicators were collected on day 4 of mechanical ventilation. By day 4, 668 patients received care under a high intensity staffing model (primary intensivist care or mandatory consult) and 193 patients received care under a low intensity staffing model (optional consultation or no intensivist). Among eligible patients, those receiving care under a high intensity staffing model were more likely to receive prophylaxis for deep vein thrombosis (risk ratio 1.08, 95% CI 1.00 to 1.17), stress ulcer prophylaxis (risk ratio 1.10, 95% CI 1.03 to 1.18), a spontaneous breathing trial (risk ratio 1.37, 95% CI 0.97 to 1.94), interruption of sedation (risk ratio 1.64, 95% CI 1.13 to 2.38) and intensive insulin treatment (risk ratio 1.40, 95% CI 1.18 to 1.79) on day 4 of mechanical ventilation. Models accounting for clustering by hospital produced similar estimates of the staffing effect, except for prophylaxis against thrombosis and stress ulcers.

Conclusions: High intensity physician staffing is associated with increased use of evidence-based quality indictors in patients receiving mechanical ventilation.

  • DVT, deep vein thrombosis
  • GEE, generalised estimating equation
  • ICU, intensive care unit
  • UHC, University HealthSystem Consortium

https://doi.org/10.1136/qshc.2007.022376

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    Footnotes

    • Funding: This study was funded by the University HealthSystem Consortium and by the individual participating hospitals. JMK is supported by a career development award from the National Institutes of Health (K23HL082650).

    • Competing interests: None.

    • The study sponsors had no role in study design, collection, analysis and interpretation of the data, writing of the report, and the decision to submit the paper for publication.