title: Intensivists improve outcomes and compliance with process measures in critically ill patients.
abstract: BACKGROUND
  Specialty-trained intensivist involvement in the care of critically ill patients has been associated with improved outcomes; however, the factors contributing to this observation are unknown. We hypothesized that intensivist-led ICU care would result in decreased mortality, length of stay, and rate of deep venous thrombosis/pulmonary embolism along with improved compliance with ICU process measures.
  
  
  METHODS
  We performed a retrospective review of 847 patients using the October 2008 transition at a regional medical center from an open ICU to a model in which board-certified intensivists assume primary responsibility or co-management of all critically ill patients. Included in the analysis were patients admitted to the ICU during the 3 months immediately before the transition (June to September 2008) and a 3-month period 1 year later (June to September 2009). End points included mortality, length of stay, and deep venous thrombosis/pulmonary embolism rates, as well as several ICU process measures.
  
  
  RESULTS
  Patients in the post-intensivist cohort had a shorter hospital length of stay (7.4 days vs 8.7 days; p = 0.009) and a trend toward decreased mortality (9.3% vs 13.3%; p = 0.086). Patients also received timely initiation of deep venous thrombosis prophylaxis more frequently and tended toward more frequent timely initiation of nutritional support. Patients in the post-intensivist cohort admitted to the ICU with sepsis demonstrated a significant decrease in mortality (11.4% vs 35.0%, p = 0.010), both overall and in patients with APACHE II scores >20.
  
  
  CONCLUSIONS
  Intensivist-led ICU care is associated with improved outcomes in patients with sepsis and possibly in all ICU patients. Compliance with selected evidence-based practices improved. Additional study is needed to understand the mechanisms by which the intensivist model improves outcomes.
authors: Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA. urog0001@umn.edu
authors: Uroghupatei P
authors: UP
authors: Iyegha
authors: Javariah I
authors: JI
authors: Asghar
authors: Elizabeth B
authors: EB
authors: Habermann
authors: Alain
authors: A
authors: Broccard
authors: Craig
authors: C
authors: Weinert
authors: Greg
authors: G
authors: Beilman
mesh_terms: D018806:APACHE; D000368:Aged; D003422:Critical Care; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000517:prevention & control; D012121:Respiration, Artificial; D012189:Retrospective Studies; D020246:Venous Thrombosis / Q000453:epidemiology / Q000517:prevention & control; D000078329:Workforce