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. 2014 Jun;86(6):319-24.
doi: 10.4174/astr.2014.86.6.319. Epub 2014 May 23.

Impact of a surgical intensivist on the clinical outcomes of patients admitted to a surgical intensive care unit

Chi-Min Park  1 , Ho-Kyung Chun  2 , Dae-Sang Lee  3 , Kyeongman Jeon  4 , Gee Young Suh  4 , Jin Cheol Jeong  5
Affiliations

Impact of a surgical intensivist on the clinical outcomes of patients admitted to a surgical intensive care unit

Chi-Min Park et al. Ann Surg Treat Res. 2014 Jun.

Abstract

Purpose: An intensivist is a key factor in the mortality of patients admitted to the intensive care unit (ICU). The aim of this study was to evaluate the effect of an intensivist on clinical outcomes of patients admitted to a surgical ICU.

Methods: During the study period, the surgical ICU was converted from an open ICU to an intensivist-directed ICU managed by an intensivist who was board certified in both general surgery and critical care medicine. We compared consecutive patients admitted to the surgical ICU before and after implementing the intensivist-directed care. The primary outcome was ICU mortality, and secondary outcomes were hospital mortality, 90-day mortality, length of hospital stay, ICU-free days, ventilator-free days, and ICU readmission rate.

Results: A total of 441 patients were included in this study: 188 before implementation of the intensivist and 253 after implementation. Clinical characteristics were not different between the two groups. ICU mortality decreased from 11.7% to 6.3% (P = 0.047) after implementation, and 90-day mortality also decreased significantly (P = 0.008). The adjusted hazard ratio of the intensivist for ICU mortality was 0.43 (95% confidence interval, 0.22-0.87; P = 0.020). ICU-free days (P = 0.013) and the hospital length of stay (P = 0.032) were significantly improved after implementing the intensivist-directed care. Before implementation period, 16.0% of patients were readmitted, compared with only 9.9% after implementation (P = 0.05).

Conclusion: Implementing intensivist-directed care in the surgical ICU was associated with significant improvements in ICU mortality and significant clinical outcomes.

Keywords: Critical illness; General surgery; Intensive care units; Mortality; Specialization.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Kaplan-Meier survival curve of the patients admitted to the surgical intensive care unit (ICU), before and after implementing an intensivist-directed ICU (Log-rank test, P = 0.013).
See this image and copyright information in PMC

References

    1. Pronovost P, Thompson DA, Holzmueller CG, Dorman T, Morlock LL. Impact of the Leapfrog Group's intensive care unit physician staffing standard. J Crit Care. 2007;22:89–96. - PubMed
    1. Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA. 2002;288:2151–2162. - PubMed
    1. Carson SS, Stocking C, Podsadecki T, Christenson J, Pohlman A, MacRae S, et al. Effects of organizational change in the medical intensive care unit of a teaching hospital: a comparison of 'open' and 'closed' formats. JAMA. 1996;276:322–328. - PubMed
    1. Ghorra S, Reinert SE, Cioffi W, Buczko G, Simms HH. Analysis of the effect of conversion from open to closed surgical intensive care unit. Ann Surg. 1999;229:163–171. - PMC - PubMed
    1. Nathens AB, Rivara FP, MacKenzie EJ, Maier RV, Wang J, Egleston B, et al. The impact of an intensivist-model ICU on trauma-related mortality. Ann Surg. 2006;244:545–554. - PMC - PubMed

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