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Intensivist physician staffing and the process of care in academic medical centres

¹ Division of Pulmonary, Allergy and Critical Care Medicine, Center for Clinical Epidemiology and Biostatistics, and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
² University Health System Consortium, Oak Brook, Illinois, USA
³ Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington, USA

Correspondence to:
Dr Jeremy M Kahn
Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, 874 Maloney Building, 3600 Spruce Street, Philadelphia, Pennsylvania 19104, USA; jkahn{at}cceb.med.upenn.edu
ABSTRACT
Background: Although intensivist physician staffing is associated with improved outcomes in critical care, little is known about the mechanism leading to this observation.

Objective: To determine the relationship between intensivist staffing and select process-based quality indicators in the intensive care unit.

Research design: Retrospective cohort study in 29 academic hospitals participating in the University HealthSystem Consortium Mechanically Ventilated Patient Bundle Benchmarking Project.

Patients: 861 adult patients receiving prolonged mechanical ventilation in an intensive care unit.

Results: Patient-level information on physician staffing and process-of-care quality indicators were collected on day 4 of mechanical ventilation. By day 4, 668 patients received care under a high intensity staffing model (primary intensivist care or mandatory consult) and 193 patients received care under a low intensity staffing model (optional consultation or no intensivist). Among eligible patients, those receiving care under a high intensity staffing model were more likely to receive prophylaxis for deep vein thrombosis (risk ratio 1.08, 95% CI 1.00 to 1.17), stress ulcer prophylaxis (risk ratio 1.10, 95% CI 1.03 to 1.18), a spontaneous breathing trial (risk ratio 1.37, 95% CI 0.97 to 1.94), interruption of sedation (risk ratio 1.64, 95% CI 1.13 to 2.38) and intensive insulin treatment (risk ratio 1.40, 95% CI 1.18 to 1.79) on day 4 of mechanical ventilation. Models accounting for clustering by hospital produced similar estimates of the staffing effect, except for prophylaxis against thrombosis and stress ulcers.

Conclusions: High intensity physician staffing is associated with increased use of evidence-based quality indictors in patients receiving mechanical ventilation.