The effect of prompt physician visits on intensive care unit mortality and cost.
OBJECTIVE
To determine the effect on mortality, length of stay, and direct variable cost of physician response time to seeing patients after intensive care unit admission.


METHODS
Retrospective analysis of the intensive care unit database.


METHODS
Medical center.


METHODS
Subjects were 840 patients who had complete direct variable cost data and a subset of 316 patients who were matched by propensity scores.


METHODS
None.


RESULTS
Median time to first visit by a physician was 6 hrs. One hundred thirty-five patients (16.1%) died in hospital compared with 25.0% predicted by Acute Physiology and Chronic Health Evaluation risk (p < .001). Higher Acute Physiology and Chronic Health Evaluation risk, older age, mechanical ventilation on arrival in the intensive care unit, and longer time until seen by a physician were predictors of hospital mortality. Each 1-hr delay in seeing the patient was associated with a 1.6% increased risk of hospital death, which further increased to 2.1% after including propensity score. However, patients seen more promptly (<6 vs. >6 hrs) had greater hospital direct variable cost ($11,992 +/- $12,043 vs. $10,355 +/- $10,368, p = .04), before controlling for acuity of illness and other factors that may have affected time to evaluation. In the subpopulation of propensity-matched patients, patients seen promptly (<6 vs. >6 hrs) had shorter hospital length of stays (11 +/- 11 vs. 13 +/- 14 days, p = .03) but similar direct variable costs ($10,963 +/- 10,778 vs. $13,016 +/- 13,006, p = .16) and similar mortality rates (24 vs. 30, p = .46).


CONCLUSIONS
In the total patient population, delay in seeing patients was associated with an increased risk of death. In the propensity-matched patients, promptly seen patients had shorter hospital stays but similar direct variable costs.
Engoren
Milo
M
Departments of Anesthesiology and Internal Medicine, St. Vincent Mercy Medical Center, Toledo, OH, USA.
D018806:APACHE; D017677:Age Distribution; D019540:Area Under Curve; D003422:Critical Care / Q000592:standards* / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units / Q000191:economics* / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008505:Medical Staff, Hospital / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D009820:Ohio / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011383:Progressive Patient Care; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D013996:Time and Motion Studies