title: Impact of Resident Rotations on Critically Ill Patient Outcomes: Results of a French Multicenter Observational Study.
abstract: OBJECTIVE
  The impact of resident rotation on patient outcomes in the intensive care unit (ICU) has been poorly studied. The aim of this study was to address this question using a large ICU database.
  
  
  METHODS
  We retrospectively analyzed the French CUB-REA database. French residents rotate every six months. Two periods were compared: the first (POST) and fifth (PRE) months of the rotation. The primary endpoint was ICU mortality. The secondary endpoints were the length of ICU stay (LOS), the number of organ supports, and the duration of mechanical ventilation (DMV). The impact of resident rotation was explored using multivariate regression, classification tree and random forest models.
  
  
  RESULTS
  262,772 patients were included between 1996 and 2010 in the database. The patient characteristics were similar between the PRE (n = 44,431) and POST (n = 49,979) periods. Multivariate analysis did not reveal any impact of resident rotation on ICU mortality (OR = 1.01, 95% CI = 0.94; 1.07, p = 0.91). Based on the classification trees, the SAPS II and the number of organ failures were the strongest predictors of ICU mortality. In the less severe patients (SAPS II<24), the POST period was associated with increased mortality (OR = 1.65, 95%CI = 1.17-2.33, p = 0.004). After adjustment, no significant association was observed between the rotation period and the LOS, the number of organ supports, or the DMV.
  
  
  CONCLUSIONS
  Resident rotation exerts no impact on overall ICU mortality at French teaching hospitals but might affect the prognosis of less severe ICU patients. Surveillance should be reinforced when treating those patients.
authors.affiliation: Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Chousterman
authors.affiliation: Service d'Anesthésie-Réanimation, Hôpital Européen Georges Pompidou, Université Paris Descartes, PRES Sorbonne Paris Cité, AP-HP, Paris, France.|Centre de Recherche en Epidémiologie, Equipe ECSTRA, INSERM 1153, PRES Sorbonne Paris Cité, Paris, France.|Department of Anesthesia and Perioperative Care, San Francisco General Hospital, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Romain
authors.initials: R
authors.lastname: Pirracchio
authors.affiliation: Service de Réanimation Médicale, Hôpital Saint-Antoine, AP-HP, Paris, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
authors.affiliation: Département d'Information Hospitalière et Santé Publique-Unité de Recherche Clinique, Hôpital Ambroise Paré, AP-HP, Boulogne, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Aegerter
authors.affiliation: Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Mentec
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005602:France; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007396:Internship and Residency / Q000458:organization & administration; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D000091402:Prohibitins; D012189:Retrospective Studies; D016896:Treatment Outcome; D000078329:Workforce