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

J Hosp Med. 2012 Mar;7(3):183-9. doi: 10.1002/jhm.972. Epub 2011 Nov 8.

Abstract

Background: 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.

Objective: To compare mortality and length of stay (LOS) of medical ICU patients cared for by a hospitalist or an intensivist-led team.

Design: Prospective observational study.

Setting: Urban academic community hospital affiliated with a major regional academic university.

Patients: Consecutive medical patients admitted to a hospitalist ICU team (n = 828) with selective intensivist consultation or an intensivist-led ICU teaching team (n = 528).

Measurements: Endpoints were ICU and in-hospital mortality and LOS, adjusted for patient differences with logistic and linear regression models and propensity scores.

Results: 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.

Conclusions: 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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Academic Medical Centers
  • Adult
  • Aged
  • Female
  • Hospital Mortality*
  • Hospitalists / organization & administration*
  • Humans
  • Intensive Care Units*
  • Logistic Models
  • Male
  • Middle Aged
  • Models, Organizational
  • Odds Ratio
  • Patient Care Team
  • Personnel Staffing and Scheduling / organization & administration*
  • Prospective Studies
  • Severity of Illness Index
  • United States
  • Workforce