Abstract
Objective: The purpose of the study was to investigate associations among intensive care unit (ICU) staffing and care processes in patients with severe sepsis. Design: An observational multicenter cross-sectional study performed from October 2007 to March 2008. Setting: Forty-nine teaching hospitals in Japan. Participants: Patients (n=576) with severe sepsis identified using ICD-10 codes from administrative data. Main outcome measures: Care processes including mechanical ventilation, dialysis, enteral feeding, parentetal nutrition, and antibiotic empirical therapy which were available in administrative data. Results: ICUs were classified as high- or low-intensity based on policies regarding the responsibilities of intensivists. There were no differences in baseline patient characteristics between the ICU groups. In the high-intensity group, ICU stay for survivors was about two days shorter and hospital stay was significantly shorter by three days. Majority of patients had high rates of enteral feeding; however, the high-intensity group had significantly earlier initiation of enteral feeding and a significantly shorter duration of mechanical ventilation. A shorter duration of mechanical ventilation was significantly associated with the ICU structure. Conclusions: The results showed an association between ICU physician and processes of intensive care, and high-intensity ICU was aggressive in mechanical ventilation in patients with severe sepsis.
Highlights
Patients in the intensive care unit (ICU) require complex care relating to a broad range of acute illnesses and pre-existing conditions
The results showed an association between ICU physician and processes of intensive care, and high-intensity ICU was aggressive in mechanical ventilation in patients with severe sepsis
We investigated the effect of ICU physicians on care processes, which were available in administrative data, in patients with severe sepsis
Summary
Patients in the intensive care unit (ICU) require complex care relating to a broad range of acute illnesses and pre-existing conditions. The innate complexity of the ICU makes organizational structuring of care an attractive quality measure and a target for performance improvement strategies. Organizational features relating to medical and nursing leadership, communication and collaboration among providers, and approaches to problem-solving may capture the quality of ICU care more comprehensively than do practices related to specific processes of care. Many authors have shown wide variations in mortality in ICU, which may have developed studies on the associations between ICU organizations and outcomes. There is many patterns in ICU organization, [3,42] and it seemed that differences in ICU organization associated with patient outcomes. ICU staffings focused on the role of intensivists in critical care units
Sign-in/Register to view highlights & summary 
Submitted Version (
Free)
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call