The benefits of 24/7 in-house intensivist coverage for prolonged-stay cardiac surgery patients.
OBJECTIVE
The objective of our study was to evaluate the efficacy of 24/7 in-house intensivist care for patients requiring prolonged intensive care unit (ICU) stay following cardiac surgery.


METHODS
A propensity-matched retrospective before-and-after observational study comparing 2 models of ICU physician staffing was undertaken. Previously, residents (with intensivist backup) provided care for patients after cardiac surgery (surgical ICU cohort). ICU physician staffing was modified with the implementation of 24/7 in-house board-certified intensivist coverage in a cardiac surgery ICU (cardiac surgery ICU cohort) for postoperative care. Patients with a prolonged ICU stay (ie, >48 hours) were identified and their outcomes analyzed for both models of care.


RESULTS
Propensity matching between cohorts was successful for 271 patients (75.7%), with matched patients being used for comparison. There was no difference in ICU or 30-day mortality. There was also no difference in ICU length of stay (LOS); however, the median hospital LOS was significantly shorter in the cardiac surgery ICU cohort (12.3 vs 11.0 days; P < .01). There was a decrease in the proportion of patients receiving transfused red blood cells in the cardiac surgery ICU cohort (80.8% vs 65.7%; P < .001). The cardiac surgery ICU cohort had reduced complications relating to sepsis (4.7% vs 0.7%; P < .01) and renal failure (22.5% vs 12.5%; P < .01); however, the identification of neurologic dysfunction was significantly higher (11.1% vs 20.7%; P < .01).


CONCLUSIONS
For patients requiring a prolonged ICU stay, our model of 24/7 in-house intensivist coverage was not associated with changes in ICU LOS, nor ICU and 30-day mortality. However a reduction in blood product use, ICU complications, and total hospital LOS was observed.
Cardiac Sciences Program, St Boniface General Hospital/I.H. Asper Clinical Research Institute, Winnipeg, Manitoba, Canada.
Kanwal
K
Kumar
Cardiac Sciences Program, St Boniface General Hospital/I.H. Asper Clinical Research Institute, Winnipeg, Manitoba, Canada.
Rohit
R
Singal
Cardiac Sciences Program, St Boniface General Hospital/I.H. Asper Clinical Research Institute, Winnipeg, Manitoba, Canada.
Rizwan A
RA
Manji
Department of Hematology/Medical Oncology, Cancercare Manitoba, Winnipeg, Manitoba, Canada; Sections of Hematology and Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Ryan
R
Zarychanski
Cardiac Sciences Program, St Boniface General Hospital/I.H. Asper Clinical Research Institute, Winnipeg, Manitoba, Canada.
Dean D
DD
Bell
Cardiac Sciences Program, St Boniface General Hospital/I.H. Asper Clinical Research Institute, Winnipeg, Manitoba, Canada.
Darren H
DH
Freed
Cardiac Sciences Program, St Boniface General Hospital/I.H. Asper Clinical Research Institute, Winnipeg, Manitoba, Canada. Electronic address: rakeshcarora@gmail.com.
Rakesh C
RC
Arora
D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D003325:Coronary Care Units; D003695:Delivery of Health Care; D017707:Erythrocyte Transfusion; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008505:Medical Staff, Hospital / Q000600:supply & distribution*; D010561:Personnel Staffing and Scheduling; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D000078329:Workforce