title: Hospitalists and intensivists in the medical ICU: a prospective observational study comparing mortality and length of stay between two staffing models.
abstract: BACKGROUND
  A 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.
  
  
  OBJECTIVE
  To compare mortality and length of stay (LOS) of medical ICU patients cared for by a hospitalist or an intensivist-led team.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Urban academic community hospital affiliated with a major regional academic university.
  
  
  METHODS
  Consecutive medical patients admitted to a hospitalist ICU team (n = 828) with selective intensivist consultation or an intensivist-led ICU teaching team (n = 528).
  
  
  METHODS
  Endpoints were ICU and in-hospital mortality and LOS, adjusted for patient differences with logistic and linear regression models and propensity scores.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  The 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.
authors: Division of Hospital Medicine, Emory University School of Medicine, Emory University Hospital Midtown (EUHM), Atlanta, GA, USA. Kristin.Wise@emoryhealthcare.org
authors: Kristin R
authors: KR
authors: Wise
authors: Valery A
authors: VA
authors: Akopov
authors: Byron R
authors: BR
authors: Williams
authors: Moges S
authors: MS
authors: Ido
authors: Kenneth V
authors: KV
authors: Leeper
authors: Daniel D
authors: DD
authors: Dressler
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D020445:Hospitalists / Q000458:organization & administration*; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D016017:Odds Ratio; D010348:Patient Care Team; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D011446:Prospective Studies; D012720:Severity of Illness Index; D014481:United States; D000078329:Workforce