Clinical impact of physician staffing transition in intensive care units: a retrospective observational study
Abstract Background Intensivists play an essential role in improving the outcomes of critically ill patients in intensive care units (ICUs). The transition of ICU physician staffing from low-intensity ICUs (elective intensivist or no intensivist consultation) to high-intensity ICUs (mandatory intens...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-11-01
|
| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-022-01905-0 |
| _version_ | 1811187022007631872 |
|---|---|
| author | Yosuke Fujii Kiichi Hirota Kentaro Muranishi Yumiko Mori Kei Kambara Yoshitaka Nishikawa Mitsuko Hashiguchi |
| author_facet | Yosuke Fujii Kiichi Hirota Kentaro Muranishi Yumiko Mori Kei Kambara Yoshitaka Nishikawa Mitsuko Hashiguchi |
| author_sort | Yosuke Fujii |
| collection | DOAJ |
| description | Abstract Background Intensivists play an essential role in improving the outcomes of critically ill patients in intensive care units (ICUs). The transition of ICU physician staffing from low-intensity ICUs (elective intensivist or no intensivist consultation) to high-intensity ICUs (mandatory intensivist consultation or a closed ICU) improves clinical outcomes. However, whether a transition from high-intensity to low-intensity ICU staffing affects ICU outcomes and quality of care remains unknown. Methods A retrospective observational study was conducted to examine the impact of high- versus low-intensity staffing models on all-cause mortality in a suburban secondary community hospital with 400 general beds and 8 ICU beds. The ICU was switched from a high-intensity staffing model (high-former period) to low-intensity staffing in July 2019 (low-mid period) and then back to high-intensity staffing in March 2020 (high-latter period). Patients admitted from the emergency department, general ward, or operating room after emergency surgery were enrolled in these three periods and compared, balancing the predicted mortality and covariates of the patients. The primary outcome was all-cause mortality analyzed using hazard ratios (HRs) from Cox proportional hazards regression. An interrupted time-series analysis (ITSA) was also conducted to evaluate the effects of events (level change) and time. Results There were 962 eligible admissions, of which 251, 213, and 498 occurred in the high-former, low-mid, and high-latter periods, respectively. In the matched group (n = 600), the all-cause mortality rate comparing the high-former period with the low-mid period showed an HR of 0.88 [95% confidence interval (CI), 0.56, 1.39; p = 0.58] and that comparing the high-latter period with the low-mid period showed an HR of 0.84 [95% CI, 0.54, 1.30; p = 0.43]. The result for comparison between the three periods was p = 0.80. ITSA showed level changes of 4.05% [95% CI, -13.1, 21.2; p = 0.63] when ICU staffing changed from the high-former to the low-mid period and 1.35% [95% CI, -13.8, 16.5; p = 0.86] when ICU staffing changed from the low-mid to the high-latter period. Conclusion There was no statistically significant difference in all-cause mortality among the three ICU staffing periods. This study suggests that low-intensity ICU staffing might not worsen clinical outcomes in the ICU in a medium-sized community hospital. Multiple factors, including the presence of an intensivist, other medical staff, and practical guidelines, influence the prognosis of critically ill patients. |
| first_indexed | 2024-04-11T13:55:13Z |
| format | Article |
| id | doaj.art-aa75383ff0d84cae874345b8a1d076bc |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-04-11T13:55:13Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-aa75383ff0d84cae874345b8a1d076bc2022-12-22T04:20:22ZengBMCBMC Anesthesiology1471-22532022-11-0122111010.1186/s12871-022-01905-0Clinical impact of physician staffing transition in intensive care units: a retrospective observational studyYosuke Fujii0Kiichi Hirota1Kentaro Muranishi2Yumiko Mori3Kei Kambara4Yoshitaka Nishikawa5Mitsuko Hashiguchi6Department of Anesthesia, Otsu City HospitalDepartment of Human Stress Response Science, Institute of Biomedical Science, Kansai Medical UniversityDepartment of Emergency and Intensive Care Medicine, Otsu City HospitalDepartment of Anesthesia, Otsu City HospitalDepartment of Anesthesia, Otsu City HospitalDepartment of Health Informatics, Kyoto University School of Public HealthDepartment of Anesthesia, Otsu City HospitalAbstract Background Intensivists play an essential role in improving the outcomes of critically ill patients in intensive care units (ICUs). The transition of ICU physician staffing from low-intensity ICUs (elective intensivist or no intensivist consultation) to high-intensity ICUs (mandatory intensivist consultation or a closed ICU) improves clinical outcomes. However, whether a transition from high-intensity to low-intensity ICU staffing affects ICU outcomes and quality of care remains unknown. Methods A retrospective observational study was conducted to examine the impact of high- versus low-intensity staffing models on all-cause mortality in a suburban secondary community hospital with 400 general beds and 8 ICU beds. The ICU was switched from a high-intensity staffing model (high-former period) to low-intensity staffing in July 2019 (low-mid period) and then back to high-intensity staffing in March 2020 (high-latter period). Patients admitted from the emergency department, general ward, or operating room after emergency surgery were enrolled in these three periods and compared, balancing the predicted mortality and covariates of the patients. The primary outcome was all-cause mortality analyzed using hazard ratios (HRs) from Cox proportional hazards regression. An interrupted time-series analysis (ITSA) was also conducted to evaluate the effects of events (level change) and time. Results There were 962 eligible admissions, of which 251, 213, and 498 occurred in the high-former, low-mid, and high-latter periods, respectively. In the matched group (n = 600), the all-cause mortality rate comparing the high-former period with the low-mid period showed an HR of 0.88 [95% confidence interval (CI), 0.56, 1.39; p = 0.58] and that comparing the high-latter period with the low-mid period showed an HR of 0.84 [95% CI, 0.54, 1.30; p = 0.43]. The result for comparison between the three periods was p = 0.80. ITSA showed level changes of 4.05% [95% CI, -13.1, 21.2; p = 0.63] when ICU staffing changed from the high-former to the low-mid period and 1.35% [95% CI, -13.8, 16.5; p = 0.86] when ICU staffing changed from the low-mid to the high-latter period. Conclusion There was no statistically significant difference in all-cause mortality among the three ICU staffing periods. This study suggests that low-intensity ICU staffing might not worsen clinical outcomes in the ICU in a medium-sized community hospital. Multiple factors, including the presence of an intensivist, other medical staff, and practical guidelines, influence the prognosis of critically ill patients.https://doi.org/10.1186/s12871-022-01905-0Intensive care unitICU staffingHigh-intensity staffingLow-intensity staffingIntensivistInterrupted time-series analysis |
| spellingShingle | Yosuke Fujii Kiichi Hirota Kentaro Muranishi Yumiko Mori Kei Kambara Yoshitaka Nishikawa Mitsuko Hashiguchi Clinical impact of physician staffing transition in intensive care units: a retrospective observational study BMC Anesthesiology Intensive care unit ICU staffing High-intensity staffing Low-intensity staffing Intensivist Interrupted time-series analysis |
| title | Clinical impact of physician staffing transition in intensive care units: a retrospective observational study |
| title_full | Clinical impact of physician staffing transition in intensive care units: a retrospective observational study |
| title_fullStr | Clinical impact of physician staffing transition in intensive care units: a retrospective observational study |
| title_full_unstemmed | Clinical impact of physician staffing transition in intensive care units: a retrospective observational study |
| title_short | Clinical impact of physician staffing transition in intensive care units: a retrospective observational study |
| title_sort | clinical impact of physician staffing transition in intensive care units a retrospective observational study |
| topic | Intensive care unit ICU staffing High-intensity staffing Low-intensity staffing Intensivist Interrupted time-series analysis |
| url | https://doi.org/10.1186/s12871-022-01905-0 |
| work_keys_str_mv | AT yosukefujii clinicalimpactofphysicianstaffingtransitioninintensivecareunitsaretrospectiveobservationalstudy AT kiichihirota clinicalimpactofphysicianstaffingtransitioninintensivecareunitsaretrospectiveobservationalstudy AT kentaromuranishi clinicalimpactofphysicianstaffingtransitioninintensivecareunitsaretrospectiveobservationalstudy AT yumikomori clinicalimpactofphysicianstaffingtransitioninintensivecareunitsaretrospectiveobservationalstudy AT keikambara clinicalimpactofphysicianstaffingtransitioninintensivecareunitsaretrospectiveobservationalstudy AT yoshitakanishikawa clinicalimpactofphysicianstaffingtransitioninintensivecareunitsaretrospectiveobservationalstudy AT mitsukohashiguchi clinicalimpactofphysicianstaffingtransitioninintensivecareunitsaretrospectiveobservationalstudy |