Implementation of 24/7 intensivist presence in the SICU: effect on processes of care.
BACKGROUND
Staffing of attending intensivists 24 hours per day, 7 days per week (24/7) in the surgical intensive care unit (SICU) has unknown benefits. We hypothesized that 24/7 attending intensivist staffing in the SICU would improve outcomes and processes of care.


METHODS
We retrospectively reviewed 26 months of admissions to our 20-bed SICU, comparing 13 months before and 13 months after addition of an in-house night intensivist to the existing day intensivist with a nighttime on-demand model. Primary outcomes were mortality, complications, SICU length of stay, and ventilator days. Secondary outcomes were use of intensivist-directed ancillary testing and therapies, as well as physician billing (relative value units per full-time equivalent [RVU/FTE]).


RESULTS
A total of 2,829 patients were included: 1,408 before and 1,421 after 24/7 staffing. Baseline characteristics, mortality, complications, ventilation days, ICU and hospital length of stay, and readmission rate were similar between groups (all p > 0.05). Use of blood products and imaging tests (computed tomographic scans) were significantly reduced. Total RVU increased, as did the RVU/FTE ratio.


CONCLUSIONS
Implementation of 24/7 staffing did not improve SICU morbidity or mortality but was associated with decreased blood product use and fewer axial imaging studies. The RVU/FTE ratio was improved. Overall health care value may be decreased under this model.


METHODS
Care management study, level IV.
Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02141, USA.
Gwendolyn M
GM
van der Wilden
Ulrich
U
Schmidt
Yuchiao
Y
Chang
Edward A
EA
Bittner
J Perren
JP
Cobb
George C
GC
Velmahos
Hasan B
HB
Alam
Marc A
MA
de Moya
David R
DR
King
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D016730:Program Development; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D000078329:Workforce; D055815:Young Adult