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Original Research
Article first published online: 8 JAN 2010
DOI: 10.1002/jhm.567
Copyright © 2010 Society of Hospital Medicine
Additional Information
How to Cite
Hyzy, R. C., Flanders, S. A., Pronovost, P. J., Berenholtz, S. M., Watson, S., George, C., Goeschel, C. A., Maselli, J. and Auerbach, A. D. (2010), Characteristics of intensive care units in Michigan: Not an open and closed case. J. Hosp. Med., 5: 4–9. doi: 10.1002/jhm.567
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The Michigan Health and Hospital Association (MHA) Keystone ICU study was supported by a grant (1UC1HS14246) from the Agency for Healthcare Research and Quality.
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Disclosure: R.C.H. attests that the authors had access to all the study data, take responsibility for the accuracy of the analysis, and had authority over manuscript preparation and the decision to submit the manuscript for publication. The authors declare the following conflicts of interest in relationship to this research publication: R.C.H. has received honoraria for consulting from MHA; S.M.B. has received grant support from Robert Wood Johnson Foundation (RWJ) and Agency for Healthcare Research and Quality (AHRQ) to improve quality of care; a career development award from the National Heart, Lung, and Blood Institute (NHLBI); and honoraria for consulting from MHA; C.A.G., S.A.F., and S.W., none; A.D.A. is an advisor to Merck, Astra Zeneca, and Amgen pharmaceuticals, and has received grants from the California Healthcare Foundation, AHRQ, and NHLBI for research to improve quality of care; and P.J.P. is an advisor to the Leapfrog Group and has grants from MHA to improve the quality of care for patients in Michigan.
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Publication History
- Issue published online: 8 JAN 2010
- Article first published online: 8 JAN 2010
- Manuscript Accepted: 25 MAY 2009
- Manuscript Revised: 20 MAY 2009
- Manuscript Received: 2 SEP 2008
- Abstract
- Article
- References
- Cited By
Keywords:
- care standardization;
- leadership;
- multidisciplinary care;
- teamwork
Abstract
OBJECTIVE:
Delivery of critical care by intensivists has been recommended by several groups. Our objective was to understand the delivery of critical care physician services in Michigan and the role of intensivists and nonintensivist providers in providing care.
DESIGN:
Descriptive questionnaire.
PARTICIPANTS AND SETTING:
Intensive care unit (ICU) directors and nurse managers at 96 sites, representing 115 ICUs from 72 hospitals in Michigan.
MEASUREMENTS AND RESULTS:
The primary outcome measure was the percentage of sites utilizing a closed vs. an open model of ICU care. Secondary outcome measures included the percentage of ICUs utilizing a high-intensity service model, hospital size, ICU size, type of clinician providing care, and clinical activities performed. Twenty-four (25%) sites used a closed model of intensive care, while 72 (75%) had an open model of care. Hospitals with closed ICUs were larger and had larger ICUs than sites with open ICUs (P < 0.05). Hospitalists serving as attending physicians were strongly associated with an open ICU (odds ratio [OR] = 12.2; 95% confidence interval [CI] = 2.5-60.2), as was the absence of intensivists in the group (OR = 12.2; 95%CI = 1.4-105.8), while ICU and hospital size were not associated. At 18 sites (20%) all attendings were board certified in Critical Care. Sixty sites had less than 50% board-certified attending physicians.
CONCLUSIONS:
The closed intensivist-led model of intensive care delivery is not in widespread use in Michigan. In the absence of intensivists, alternate models of care, including the hospitalist model, are frequently used. Journal of Hospital Medicine 2010;5:4–9. © 2010 Society of Hospital Medicine.