Influence of a high-intensity staffing model in a cardiac surgery intensive care unit on postoperative clinical outcomes

Abstract

ObjectiveVarious staffing models have been applied in intensive care units (ICUs) to improve outcomes. However, there is a lack of evidence regarding the effect of staffing models in cardiac surgery ICUs. Thus, we aimed to evaluate the efficacy of high-intensity staffing in cardiac surgery ICUs. MethodsFrom January 2013 to December 2016, 4676 adult patients were admitted to our cardiac surgery ICU after surgery. Excluding patients undergoing minor surgery or noncardiac-related surgery, 4038 patients were analyzed. Beginning in January 2015, patients were divided into low-intensity group (n = 1784) and high-intensity group (n = 2254) according to the study period. Primary outcomes were ICU and hospital length of stay, rates of transfusion and infection, and readmission to the ICU. Secondary outcomes were 30-day and ICU mortality. To reduce potential confounders, propensity score-matched analysis was performed. ResultsIn the high-intensity group, ICU and hospital length of stay were significantly shorter (P < .001). Incidence of readmission was lower in the high-intensity group (3.1% vs 12.5%; P < .05). Infection rate in respiratory tract and bloodstream was lower in the high-intensity group (3.1% vs 5.0%; P < .05). Transfusion rate and amount were also significantly lower in the high-intensity group (P < .05). However, 30-day (1.9% vs 2.1%; P = .71) and ICU mortality (2.1% vs 2.7%; P = .31) were comparable between the groups. ConclusionsHigh-intensity staffing model during daytime hours by cardiac surgery intensivists significantly improved ICU-related outcomes. However, high-intensity staffing did not affect early mortality after cardiac surgery.