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J Crit Care. 2016 Jun;33:14-8. doi: 10.1016/j.jcrc.2016.02.009. Epub 2016 Feb 24.

The organizational structure of an intensive care unit influences treatment of hypotension among critically ill patients: A retrospective cohort study.

Author information

1
Department of Anesthesia, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA.
2
Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, MA; School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
3
Mount Sinai School of Medicine, New York City, NY.
4
Division of Health Sciences and Technology, Harvard-Massachusetts Institute of Technology, Cambridge, MA.
5
Department of Anesthesia, Beth Israel Deaconess Medical Center, Boston, MA.
6
Harvard Medical School, Boston, MA; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA. Electronic address: mhacker@bidmc.harvard.edu.

Abstract

PURPOSE:

Prior studies report that weekend admission to an intensive care unit is associated with increased mortality, potentially attributed to the organizational structure of the unit. This study aims to determine whether treatment of hypotension, a risk factor for mortality, differs according to level of staffing.

METHODS:

Using the Multiparameter Intelligent Monitoring in Intensive Care database, we conducted a retrospective study of patients admitted to an intensive care unit at Beth Israel Deaconess Medical Center who experienced one or more episodes of hypotension. Episodes were categorized according to the staffing level, defined as high during weekday daytime (7 am-7 pm) and low during weekends or nighttime (7 pm-7 am).

RESULTS:

Patients with a hypotensive event on a weekend were less likely to be treated compared with those that occurred during the weekday daytime (P = .02). No association between weekday daytime vs weekday nighttime staffing levels and treatment of hypotension was found (risk ratio, 1.02; 95% confidence interval, 0.98-1.07).

CONCLUSION:

Patients with a hypotensive event on a weekend were less likely to be treated than patients with an event during high-staffing periods. No association between weekday nighttime staffing and hypotension treatment was observed. We conclude that treatment of a hypotensive episode relies on more than solely staffing levels.

KEYWORDS:

Critical care; Hospital medical staff; Hypotension; Intensive care unit; Resuscitation

PMID:
26975737
PMCID:
PMC4842333
DOI:
10.1016/j.jcrc.2016.02.009
[Indexed for MEDLINE]
Free PMC Article

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