Intensivist physician staffing and the process of care in academic medical centres.
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.


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


METHODS
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 indicators in patients receiving mechanical ventilation.
Kahn
Jeremy M
JM
Division 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 19104, USA. jkahn@cceb.med.upenn.edu
Brake
Helga
H
Steinberg
Kenneth P
KP
D019985:Benchmarking; D018890:Chemoprevention; D015331:Cohort Studies; D003422:Critical Care; D019317:Evidence-Based Medicine; D017052:Hospital Mortality; D006785:Hospitals, University / Q000592:standards*; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D007362:Intensive Care Units; D017146:Models, Organizational; D010561:Personnel Staffing and Scheduling; D003668:Pressure Ulcer / Q000517:prevention & control; D017064:Process Assessment, Health Care; D019984:Quality Indicators, Health Care; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014481:United States; D020246:Venous Thrombosis / Q000517:prevention & control; D000078329:Workforce
D007328:Insulin