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Original Research
Hospitalists and intensivists in the medical ICU: A prospective observational study comparing mortality and length of stay between two staffing models†
Article first published online: 8 NOV 2011
DOI: 10.1002/jhm.972
Copyright © 2011 Society of Hospital Medicine
Additional Information
How to Cite
Wise, K. R., Akopov, V. A., Williams, B. R., Ido, M. S., Leeper, K. V. and Dressler, D. D. (2012), Hospitalists and intensivists in the medical ICU: A prospective observational study comparing mortality and length of stay between two staffing models. J. Hosp. Med., 7: 183–189. doi: 10.1002/jhm.972
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Disclosure: This study was supported by grants from the Carlyle Fraser Heart Center and the Department of Medicine at Emory University. The funders had no role in the study design, data collection, data analysis and interpretation, or manuscript writing. No potential conflict of interest relevant to this article was reported.
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Telephone: 404-433-8608 or 404-686-6730; Fax: 404-686-4837
Publication History
- Issue published online: 4 MAR 2012
- Article first published online: 8 NOV 2011
- Manuscript Accepted: 15 AUG 2011
- Manuscript Revised: 12 JUL 2011
- Manuscript Received: 23 MAR 2011
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. Journal of Hospital Medicine 2011;. © 2011 Society of Hospital Medicine