Abstract
IntroductionResearch has demonstrated that intensivist-led care of the critically ill is associated with reduced intensive care unit (ICU) and hospital mortality. The objective of this study was to evaluate whether a relation exists between intensivist cover pattern (for example, number of days of continuous cover) and patient outcomes among adult general ICUs in England.MethodsWe conducted a retrospective cohort study by using data from a pooled case mix and outcome database of adult general critical care units participating in the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme. Consecutive admissions to participating units for the years 2010 to 2011 were linked to a survey of intensivist cover practices. Our primary outcome of interest was mortality at ultimate discharge from acute-care hospital.ResultsThe analysis included 80,122 patients admitted to 130 ICUs in 128 hospitals. Multivariable logistic regression analysis was used to assess the relation between intensivist cover patterns (days of continuous cover, grade of physician staffing at nighttime, and frequency of daily handovers) and acute hospital mortality, adjusting for patient case mix. No relation was seen between days of continuous cover by a single intensivist or grade of physician staffing at nighttime and acute hospital mortality. Acute hospital mortality and ICU length of stay were not associated with intensivist characteristics, intensivist full-time equivalents per bed, or years of clinical experience. Intensivist participation in handover was associated with increased mortality (odds ratio, 1.27; 95% confidence interval, 1.04 to 1.55); however, only nine units reported no intensivist participation.ConclusionsWe found no relation between days of continuous cover by a single intensivist or grade of physician staffing at nighttime and patient outcomes in adult, general ICUs in England. Intensivist participation in handover was associated with increased mortality; further research to confirm or refute this finding is required.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0491-3) contains supplementary material, which is available to authorized users.
Highlights
Research has demonstrated that intensivist-led care of the critically ill is associated with reduced intensive care unit (ICU) and hospital mortality
We examine the relation between intensivist cover pattern and patient outcomes in adult, general ICUs in England
This study failed to demonstrate a relation between days of continuous cover by a single intensivist or grade of physician staffing at nighttime and risk-adjusted acute hospital mortality in patients admitted to adult, general ICUs in England
Summary
Research has demonstrated that intensivist-led care of the critically ill is associated with reduced intensive care unit (ICU) and hospital mortality. In a 1999 report by the UK Audit Commission, higherthan-expected acute hospital mortality was reported for ICUs with sessional allocation, where an intensivist worked a set number of sessions each week (for example, every Tuesday morning), compared with those with weekly allocation, in which an intensivist worked in the ICU for a week [6]. This finding was subsequently supported by other observational studies [7,8]. The UK Intercollegiate Board for Training in Intensive Care Medicine and the Intensive Care Society (ICS) have suggested that the shortages in appropriately and fully trained intensivists may play a role in limiting its implementation [9]
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