TY - JOUR
T1 - Implementation of 24/7 intensivist presence in the SICU
T2 - Effect on processes of care
AU - Van Der Wilden, Gwendolyn M.
AU - Schmidt, Ulrich
AU - Chang, Yuchiao
AU - Bittner, Edward A.
AU - Cobb, J. Perren
AU - Velmahos, George C.
AU - Alam, Hasan B.
AU - De Moya, Marc A.
AU - King, David R.
N1 - Copyright:
Copyright 2013 Elsevier B.V., All rights reserved.
PY - 2013/2
Y1 - 2013/2
N2 - 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.
AB - 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.
KW - 24/7
KW - Intensive care
KW - Intensivist
KW - Leapfrog
KW - Surgical intensive care unit
UR - http://www.scopus.com/inward/record.url?scp=84875255364&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84875255364&partnerID=8YFLogxK
U2 - 10.1097/TA.0b013e31827880a8
DO - 10.1097/TA.0b013e31827880a8
M3 - Article
C2 - 23354251
AN - SCOPUS:84875255364
SN - 2163-0755
VL - 74
SP - 563
EP - 567
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 2
ER -