Implementation of 24/7 intensivist presence in the SICU: Effect on processes of care

Gwendolyn M. Van Der Wilden, Ulrich Schmidt, Yuchiao Chang, Edward A. Bittner, J. Perren Cobb, George C. Velmahos, Hasan B. Alam, Marc A. De Moya, David R. King*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

BACKGROUND: Staffing of attending intensivists 24 hours per day, 7 days per week (24/7) in the surgical intensive care unit (SICU) has unknown benefits.We hypothesized that 24/7 attending intensivist staffing in the SICUwould improve outcomes and processes of care. METHODS: We retrospectively reviewed 26 months of admissions to our 20-bed SICU, comparing 13 months before and 13 months after addition of an in-house night intensivist to the existing day intensivist with a nighttime on-demand model. Primary outcomes were mortality, complications, SICU length of stay, and ventilator days. Secondary outcomes were use of intensivist-directed ancillary testing and therapies, as well as physician billing (relative value units per full-time equivalent [RVU/FTE]). RESULTS: A total of 2,829 patients were included: 1,408 before and 1,421 after 24/7 staffing. Baseline characteristics, mortality, complications, ventilation days, ICU and hospital length of stay, and readmission rate were similar between groups (all p > 0.05). Use of blood products and imaging tests (computed tomographic scans) were significantly reduced. Total RVU increased, as did the RVU/FTE ratio. CONCLUSION: Implementation of 24/7 staffing did not improve SICU morbidity or mortality but was associated with decreased blood product use and fewer axial imaging studies. The RVU/FTE ratio was improved. Overall health care value may be decreased under this model.

Original languageEnglish (US)
Pages (from-to)563-567
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume74
Issue number2
DOIs
StatePublished - Feb 2013
Externally publishedYes

Keywords

  • 24/7
  • Intensive care
  • Intensivist
  • Leapfrog
  • Surgical intensive care unit

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Implementation of 24/7 intensivist presence in the SICU: Effect on processes of care'. Together they form a unique fingerprint.

Cite this