• J Hosp Med · Mar 2012

    Comparative Study

    Hospitalists and intensivists in the medical ICU: a prospective observational study comparing mortality and length of stay between two staffing models.

    • Kristin R Wise, Valery A Akopov, Byron R Williams, Moges S Ido, Kenneth V Leeper, and Daniel D Dressler.
    • Division of Hospital Medicine, Emory University School of Medicine, Emory University Hospital Midtown (EUHM), Atlanta, GA, USA. Kristin.Wise@emoryhealthcare.org
    • J Hosp Med. 2012 Mar 1;7(3):183-9.

    BackgroundA shortage of critical care specialists or intensivists, coupled with expanding United States critical care needs, mandates identification of alternate qualified physicians for intensive care unit (ICU) staffing.ObjectiveTo compare mortality and length of stay (LOS) of medical ICU patients cared for by a hospitalist or an intensivist-led team.DesignProspective observational study.SettingUrban academic community hospital affiliated with a major regional academic university.PatientsConsecutive medical patients admitted to a hospitalist ICU team (n = 828) with selective intensivist consultation or an intensivist-led ICU teaching team (n = 528).MeasurementsEndpoints were ICU and in-hospital mortality and LOS, adjusted for patient differences with logistic and linear regression models and propensity scores.ResultsThe odds ratio adjusted for disease severity for in-hospital mortality was 0.8 (95% confidence interval [CI]: 0.49, 1.18; P = 0.23) and ICU mortality was 0.8 (95% CI: 0.51, 1.32; P = 0.41), referent to the hospitalist team. The adjusted LOS was similar between teams (hospital LOS difference 0.9 days, P = 0.98; ICU LOS difference 0.3 days, P = 0.32). Mechanically ventilated patients with intermediate illness severity had lower hospital LOS (10.6 vs 17.8 days, P < 0.001) and ICU LOS (7.2 vs 10.6 days, P = 0.02), and a trend towards decreased in-hospital mortality (15.6% vs 27.5%, P = 0.10) in the intensivist-led group.ConclusionsThe adjusted mortality and LOS demonstrated no statistically significant difference between hospitalist and intensivist-led ICU models. Mechanically ventilated patients with intermediate illness severity showed improved LOS and a trend towards improved mortality when cared for by an intensivist-led ICU teaching team.Copyright © 2011 Society of Hospital Medicine.

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