Hospitalists and intensivists in the medical ICU: a prospective observational study comparing mortality and length of stay between two staffing models.

A shortage of critical care specialists or intensivists, coupled with expanding United States critical care needs, mandates identification of alternate qualified physicians for intensive care unit (ICU) staffing. To compare mortality and length of stay (LOS) of medical ICU patients cared for by a hospitalist or an intensivist-led team. Prospective observational study. Urban academic community hospital affiliated with a major regional academic university. Consecutive medical patients admitted to a hospitalist ICU team (n = 828) with selective intensivist consultation or an intensivist-led ICU teaching team (n = 528). Endpoints were ICU and in-hospital mortality and LOS, adjusted for patient differences with logistic and linear regression models and propensity scores. The odds ratio adjusted for disease severity for in-hospital mortality was 0.8 (95% confidence interval [CI]: 0.49, 1.18; P = 0.23) and ICU mortality was 0.8 (95% CI: 0.51, 1.32; P = 0.41), referent to the hospitalist team. The adjusted LOS was similar between teams (hospital LOS difference 0.9 days, P = 0.98; ICU LOS difference 0.3 days, P = 0.32). Mechanically ventilated patients with intermediate illness severity had lower hospital LOS (10.6 vs 17.8 days, P < 0.001) and ICU LOS (7.2 vs 10.6 days, P = 0.02), and a trend towards decreased in-hospital mortality (15.6% vs 27.5%, P = 0.10) in the intensivist-led group. The adjusted mortality and LOS demonstrated no statistically significant difference between hospitalist and intensivist-led ICU models. Mechanically ventilated patients with intermediate illness severity showed improved LOS and a trend towards improved mortality when cared for by an intensivist-led ICU teaching team.

Wise KR ，Akopov VA ，Williams BR Jr ，Ido MS ，Leeper KV Jr ，Dressler DD ... -  《-》

Do faculty intensivists have better outcomes when caring for patients directly in a closed ICU versus consulting in an open ICU?

Hackner D ，Shufelt CL ，Balfe DD ，Lewis MI ，Elsayegh A ，Braunstein GD ，Mosenifar Z ... -  《-》

Improved survival with hospitalists in a pediatric intensive care unit.

Tenner PA ，Dibrell H ，Taylor RP 《CRITICAL CARE MEDICINE》

Continuity of care in intensive care units: a cluster-randomized trial of intensivist staffing.

Ali NA ，Hammersley J ，Hoffmann SP ，O'Brien JM Jr ，Phillips GS ，Rashkin M ，Warren E ，Garland A ，Midwest Critical Care Consortium ... -  《-》

Multidisciplinary Critical Care and Intensivist Staffing: Results of a Statewide Survey and Association With Mortality.

The role of multidisciplinary teams in improving the care of intensive care unit (ICU) patients is not well defined, and it is unknown whether the use of such teams helps to explain prior research suggesting improved mortality with intensivist staffing. We sought to investigate the association between multidisciplinary team care and survival of medical and surgical patients in nonspecialty ICUs. We conducted a community-based, retrospective cohort study of data from 60 330 patients in 181 hospitals participating in a statewide public reporting initiative, the California Hospital Assessment and Reporting Taskforce (CHART). Patient-level data were linked with ICU organizational data collected from a survey of CHART hospital ICUs between December 2010 and June 2011. Clustered logistic regression was used to evaluate the independent effect of multidisciplinary care on the in-hospital mortality of medical and surgical ICU patients. Interactions between multidisciplinary care and intensity of physician staffing were examined to explore whether team care accounted for differences in patient outcomes. After adjustment for patient characteristics and interactions, there was no association between team care and mortality for medical patients. Among surgical patients, multidisciplinary care was associated with a survival benefit (odds ratio 0.79; 95% confidence interval (CI), 0.62-1.00; P = .05). When stratifying by intensity of physician staffing, although the lowest odds of death were observed for surgical patients cared for in ICUs with multidisciplinary teams and high-intensity staffing (odds ratio, 0.77; 95% CI, 0.55-1.09; P = .15), followed by ICUs with multidisciplinary teams and low-intensity staffing (odds ratio 0.84, 95% CI 0.65-1.09, p = 0.19), these differences were not statistically significant. Our results suggest that multidisciplinary team care may improve outcomes for critically ill surgical patients. However, no relationship was observed between intensity of physician staffing and mortality.

Yoo EJ ，Edwards JD ，Dean ML ，Dudley RA ... -  《-》