title: The organizational structure of an intensive care unit influences treatment of hypotension among critically ill patients: A retrospective cohort study.
abstract: Prior studies report that weekend admission to an intensive care unit is associated with increased mortality, potentially attributed to the organizational structure of the unit. This study aims to determine whether treatment of hypotension, a risk factor for mortality, differs according to level of staffing.
  
  
  
  Using the Multiparameter Intelligent Monitoring in Intensive Care database, we conducted a retrospective study of patients admitted to an intensive care unit at Beth Israel Deaconess Medical Center who experienced one or more episodes of hypotension. Episodes were categorized according to the staffing level, defined as high during weekday daytime (7 am-7 pm) and low during weekends or nighttime (7 pm-7 am).
  
  
  
  Patients with a hypotensive event on a weekend were less likely to be treated compared with those that occurred during the weekday daytime (P = .02). No association between weekday daytime vs weekday nighttime staffing levels and treatment of hypotension was found (risk ratio, 1.02; 95% confidence interval, 0.98-1.07).
  
  
  
  Patients with a hypotensive event on a weekend were less likely to be treated than patients with an event during high-staffing periods. No association between weekday nighttime staffing and hypotension treatment was observed. We conclude that treatment of a hypotensive episode relies on more than solely staffing levels.
authors.affiliation: Department of Anesthesia, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: M Dustin
authors.initials: MD
authors.lastname: Boone
authors.affiliation: Department of Anesthesia, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Massa
authors.affiliation: Department of Anesthesia, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Ariel
authors.initials: A
authors.lastname: Mueller
authors.affiliation: Department of Anesthesia, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Sayuri P
authors.initials: SP
authors.lastname: Jinadasa
authors.affiliation: Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, MA; School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
authors.forename: Joon
authors.initials: J
authors.lastname: Lee
authors.affiliation: Mount Sinai School of Medicine, New York City, NY.
authors.forename: Rishi
authors.initials: R
authors.lastname: Kothari
authors.affiliation: Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, MA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Scott
authors.affiliation: Department of Anesthesia, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Julie
authors.initials: J
authors.lastname: Callahan
authors.affiliation: Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, MA.
authors.forename: Leo Anthony
authors.initials: LA
authors.lastname: Celi
authors.affiliation: Harvard Medical School, Boston, MA; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: mhacker@bidmc.harvard.edu.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Hacker
mesh_terms: D039602:After-Hours Care / Q000458:organization & administration*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016638:Critical Illness; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007022:Hypotension / Q000628:therapy*; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Critical care; Hospital medical staff; Hypotension; Intensive care unit; Resuscitation