title: Mature trauma intensivist model improves intensive care unit efficiency but not mortality.
abstract: BACKGROUND
  Although the Leap Frog intensivist staffing model has been shown to improve outcomes in the intensive care unit (ICU), to date, no one has examined the effect of an intensivist model in a dedicated trauma ICU. With stricter adherence to evidence-based protocols and 24-hour availability, we hypothesized that a mature intensivist model in a trauma ICU would decrease mortality.
  
  
  METHODS
  Level II trauma center trauma ICU admissions 2006 to 2011. The ICU care provided by 6 trauma intensivists. Two periods were compared: early (2006-2008) and mature (2009-2011). Patients matched on age, Injury Severity Score (ISS), preexisting conditions, and so on in a univariate analysis, with significant variables placed in a logistic regression model, with mortality as the outcome.
  
  
  RESULTS
  A total of 3527 patients (2999 excluding do not resuscitate status) were reviewed. Age ≥65 (odds ratio [OR] 2.38, P < .001), ISS ≥17 (OR 3.3, P < .001), coagulopathy (OR 1.64, P = .004), and anemia (OR 1.73, P = .02) were independent predictors of mortality. Multivariate logistic model encompassing these factors found no statistically significant differences in mortality across the 6-year period. The ICU efficiency showed significant improvements in terms of ventilator days (30.1% EARLY vs 24.4% MATURE; P < .001), decreases in mean consultant use per patient (0.55 ± 0.85 EARLY vs 0.40 ± 0.74 MATURE; P < .001), and increase in number of bedside procedures per patient (0.09 ± 0.48 EARLY vs 0.40 ± 0.74 MATURE; P < .001 CONCLUSIONS: Our mature intensivists staffing model shows improvement in ICU throughput (ventilator days, ICU days, decreased consultant use, and increased bedside procedures) but no survival benefit. Further improvements in overall trauma mortality may lie in the resuscitative and operative phase of patient care.
authors.affiliation: Trauma Services, Lancaster General Health, Lancaster, Pennsylvania jclee@lghealth.org.
authors.forename: John
authors.initials: J
authors.lastname: Lee
authors.affiliation: Trauma Services, Lancaster General Health, Lancaster, Pennsylvania.
authors.forename: Frederick
authors.initials: F
authors.lastname: Rogers
authors.affiliation: Trauma Services, Lancaster General Health, Lancaster, Pennsylvania.
authors.forename: Amelia
authors.initials: A
authors.lastname: Rogers
authors.affiliation: Trauma Services, Lancaster General Health, Lancaster, Pennsylvania.
authors.forename: Michael
authors.initials: M
authors.lastname: Horst
authors.affiliation: Trauma Services, Lancaster General Health, Lancaster, Pennsylvania.
authors.forename: Roxanne
authors.initials: R
authors.lastname: Chandler
authors.affiliation: Trauma Services, Lancaster General Health, Lancaster, Pennsylvania.
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: Miller
mesh_terms: D000367:Age Factors; D017598:Efficiency, Organizational / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000458:organization & administration* / Q000706:statistics & numerical data; D016015:Logistic Models; D017146:Models, Organizational; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D064266:Preexisting Condition Coverage; D012189:Retrospective Studies; D014193:Trauma Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000401:mortality
keywords: efficiency; intensivist model; mortality; trauma