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J Thorac Cardiovasc Surg. 2014 Jul;148(1):290-297.e6. doi: 10.1016/j.jtcvs.2014.02.074. Epub 2014 Mar 2.

The benefits of 24/7 in-house intensivist coverage for prolonged-stay cardiac surgery patients.

Author information

  • 1Cardiac Sciences Program, St Boniface General Hospital/I.H. Asper Clinical Research Institute, Winnipeg, Manitoba, Canada.
  • 2Department of Hematology/Medical Oncology, Cancercare Manitoba, Winnipeg, Manitoba, Canada; Sections of Hematology and Critical Care Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
  • 3Cardiac Sciences Program, St Boniface General Hospital/I.H. Asper Clinical Research Institute, Winnipeg, Manitoba, Canada. Electronic address: rakeshcarora@gmail.com.

Abstract

OBJECTIVE:

The objective of our study was to evaluate the efficacy of 24/7 in-house intensivist care for patients requiring prolonged intensive care unit (ICU) stay following cardiac surgery.

METHODS:

A propensity-matched retrospective before-and-after observational study comparing 2 models of ICU physician staffing was undertaken. Previously, residents (with intensivist backup) provided care for patients after cardiac surgery (surgical ICU cohort). ICU physician staffing was modified with the implementation of 24/7 in-house board-certified intensivist coverage in a cardiac surgery ICU (cardiac surgery ICU cohort) for postoperative care. Patients with a prolonged ICU stay (ie, >48 hours) were identified and their outcomes analyzed for both models of care.

RESULTS:

Propensity matching between cohorts was successful for 271 patients (75.7%), with matched patients being used for comparison. There was no difference in ICU or 30-day mortality. There was also no difference in ICU length of stay (LOS); however, the median hospital LOS was significantly shorter in the cardiac surgery ICU cohort (12.3 vs 11.0 days; P < .01). There was a decrease in the proportion of patients receiving transfused red blood cells in the cardiac surgery ICU cohort (80.8% vs 65.7%; P < .001). The cardiac surgery ICU cohort had reduced complications relating to sepsis (4.7% vs 0.7%; P < .01) and renal failure (22.5% vs 12.5%; P < .01); however, the identification of neurologic dysfunction was significantly higher (11.1% vs 20.7%; P < .01).

CONCLUSIONS:

For patients requiring a prolonged ICU stay, our model of 24/7 in-house intensivist coverage was not associated with changes in ICU LOS, nor ICU and 30-day mortality. However a reduction in blood product use, ICU complications, and total hospital LOS was observed.

Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

PMID:
24703332
[PubMed - indexed for MEDLINE]
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