Staffing intensive care units with critical care physicians may improve clinical outcomes

Kaboli, Peter J. MD, MS

Division of General Internal Medicine; University of Iowa Carver College of Medicine and Iowa City; VA Medical Center; Iowa City, USA

Abstracted from:Pronovost P, Angus D, Dorman T et al. Physician staffing patterns and clinical outcomes in critically ill patients. JAMA 2002; 288: 2151-2162 .

Sources of funding: Not specified.

Correspondence to: D Angus, CRISMA Laboratory, Department of Critical Care Medicine, University of Pittsburgh, USA. Email: [email protected]

Abstract provided by Bazian Ltd, London

Evidence-based Healthcare 7(2):p 63-64, June 2003.

BACKGROUND

Considerable resources are spent caring for people in intensive care units (ICUs). The organisation and staffing of ICUs varies considerably. The effect of these staffing variations on patient outcomes remains unclear. It has been suggested that ICUs staffed with critical care physicians (intensivists) may have improved clinical outcomes. Having physicians with skills to treat critically ill patients available may reduce morbidity and mortality.

OBJECTIVE

To assess the relationship between physician staffing and patient outcomes in intensive care units.

METHOD

Systematic review with meta-analysis.

SEARCH STRATEGY

The authors searched MEDLINE, EMBASE, HealthSTAR, Health Services Research Projects in Progress, the Cochrane Library and abstract proceedings from intensive care national scientific meetings through 2001. There were no language restrictions.

INCLUSION/EXCLUSION CRITERIA

Randomised trials and controlled observational studies of critically ill adults or children were eligible if they assessed ICU attending physician staffing strategies and outcomes. Twenty-six observational studies were included, one of which included two comparisons of alternative staffing strategies. Twenty studies focused on a single ICU. The authors categorised ICU physician staffing as 'low intensity' (no intensivist or elective intensivist consultation) or 'high intensity' (mandatory intensivist consultation or closed ICU - all care directed by intensivist).

OUTCOMES

Hospital and ICU mortality; length of hospital stay.

MAIN RESULTS

Compared with low intensity staffing, high intensity staffing was associated with lower hospital mortality (pooled relative risk 0.71, 95% CI 0.62 to 0.82), lower ICU mortality (pooled relative risk 0.61, 95% CI 0.50 to 0.75) and reduced hospital and ICU stays.

AUTHORS' CONCLUSIONS

Staffing intensive care units with critical care specialists may reduce mortality and hospital stay compared with low intensity physician staffing.