title: Intensive care unit physician staffing is associated with decreased length of stay, hospital cost, and complications after esophageal resection.
abstract: OBJECTIVE
  To determine whether having daily rounds by an intensive care unit (ICU) physician is associated with clinical and economic outcomes after esophageal resection.
  
  
  METHODS
  ICU information was obtained from a prospective survey and linked to retrospective patient data from the Maryland Health Services Cost Review Commission. The main outcome variables were in-hospital mortality rate, length of stay, hospital cost, and complications after esophageal resection.
  
  
  METHODS
  Nonfederal acute care hospitals in Maryland that performed esophageal resection (n = 35 hospitals) during the study period, 1994-1998.
  
  
  METHODS
  Adult patients who underwent esophageal resection in Maryland (n = 366 patients) from 1994 to 1998.
  
  
  METHODS
  Presence vs. absence of daily rounds by an ICU physician.
  
  
  RESULTS
  After adjusting for patient case-mix and other hospital characteristics, lack of daily rounds by an ICU physician was independently associated with a 73% increase in hospital length of stay (7 days; 95% confidence interval [CI], 1-15; p =.012) and a 61% increase in total hospital cost ($8,839; 95% CI, $ 1,674-$19,192; p =.013), but there was no association with in-hospital mortality rate. In addition, the following postoperative complications were independently associated with lack of daily rounds by an ICU physician: pulmonary insufficiency (odds ratio [OR], 4.0; CI, 1.4-11.0), renal failure (OR, 6.3; CI, 1.4-28.7), aspiration (OR, 1.7; CI, 1.0-2.8), and reintubation (OR, 2.8; CI, 1.5-5.2).
  
  
  CONCLUSIONS
  Having daily rounds by an ICU physician is associated with shorter lengths of stay, lower hospital cost, and decreased frequency of postoperative complications after esophageal resection. Healthcare providers and policymakers should use this information to help improve quality of care and reduce costs for patients undergoing high-risk surgical procedures.
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine and Hygiene and Public Health, Baltimore, MD, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Dimick
authors.forename: P J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: R F
authors.initials: RF
authors.lastname: Heitmiller
authors.forename: P A
authors.initials: PA
authors.lastname: Lipsett
mesh_terms: D015897:Comorbidity; D004947:Esophagus / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D007902:Length of Stay; D008297:Male; D008396:Maryland; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010819:Physician's Role; D011182:Postoperative Care / Q000191:economics*; D011183:Postoperative Complications; D011446:Prospective Studies