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  • Garland, Allan  (6)
  • Gershengorn, Hayley B.  (6)
  • 1
    Online Resource
    Online Resource
    Association Between Consecutive Days Worked by Intensivists and Outcomes for Critically Ill Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Critical Care Medicine Vol. 48, No. 4 ( 2020-04), p. 594-598
    Details
    In: Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 4 ( 2020-04), p. 594-598
    Abstract: To evaluate the association between consecutive days worked by intensivists and ICU patient outcomes. Design: Retrospective cohort study linked with survey data. Setting: Australia and New Zealand ICUs. Patients: Adults (16+ yr old) admitted to ICU in the Australia New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Registries (July 1, 2016, to June 30, 2018). Interventions: None. Measurements and Main Results: We linked data on staffing schedules for each unit from the Critical Care Resources Registry 2016–2017 annual survey with patient-level data from the Adult Patient Database. The a priori chosen primary outcome was ICU length of stay. Secondary outcomes included hospital length of stay, ICU readmissions, and mortality (ICU and hospital). We used multilevel multivariable regression modeling to assess the association between days of consecutive intensivist service and patient outcomes; the predicted probability of death was included as a covariate and individual ICU as a random effect. The cohort included 225,034 patients in 109 ICUs. Intensivists were scheduled for seven or more consecutive days in 43 (39.4%) ICUs; 27 (24.7%) scheduled intensivists for 5 days, 22 (20.1%) for 4 days, seven (6.4%) for 3 days, four (3.7%) for 2 days, and six (5.5%) for less than or equal to 1 day. Compared with care by intensivists working 7+ consecutive days (adjusted ICU length of stay = 2.85 d), care by an intensivist working 3 or fewer consecutive days was associated with shorter ICU length of stay (3 consecutive days: 0.46 d fewer, p = 0.010; 2 consecutive days: 0.77 d fewer, p 〈 0.001; ≤ 1 consecutive days: 0.68 d fewer, p 〈 0.001). Shorter schedules of consecutive intensivist days worked were also associated with trends toward shorter hospital length of stay without increases in ICU readmissions or hospital mortality. Conclusions: Care by intensivists working fewer consecutive days is associated with reduced ICU length of stay without negatively impacting mortality.
    Type of Medium: Online Resource
    ISSN: 0090-3493
    URL: Article
    DOI: 10.1097/CCM.0000000000004202
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2034247-0
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  • 2
    Online Resource
    Online Resource
    Association of Intensive Care Unit Patient-to-Intensivist Ratios With Hospital Mortality
    American Medical Association (AMA) ; 2017
    In:  JAMA Internal Medicine Vol. 177, No. 3 ( 2017-03-01), p. 388-
    Details
    In: JAMA Internal Medicine, American Medical Association (AMA), Vol. 177, No. 3 ( 2017-03-01), p. 388-
    Type of Medium: Online Resource
    ISSN: 2168-6106
    URL: Article
    DOI: 10.1001/jamainternmed.2016.8457
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2017
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  • 3
    Online Resource
    Online Resource
    Variation of Arterial and Central Venous Catheter Use in United States Intensive Care Units
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Anesthesiology Vol. 120, No. 3 ( 2014-03-01), p. 650-664
    Details
    In: Anesthesiology, Ovid Technologies (Wolters Kluwer Health), Vol. 120, No. 3 ( 2014-03-01), p. 650-664
    Abstract: Arterial catheters (ACs) and central venous catheters (CVCs) are common in intensive care units (ICUs). Few data describe which patients receive these devices and whether variability in practice exists. Methods: The authors conducted an observational cohort study on adult patients admitted to ICU during 2001–2008 by using Project IMPACT to determine whether AC and CVC use is consistent across U.S. ICUs. The authors examined trends over time and patients more (mechanically ventilated or on vasopressors) or less (predicted risk of hospital mortality ≤2%) likely to receive either catheter. Results: Our cohort included 334,123 patients across 122 hospitals and 168 ICUs. Unadjusted AC usage rates remained constant (36.9% [2001] vs. 36.4% [2008] ; P = 0.212), whereas CVC use increased (from 33.4% [2001] to 43.8% [2008] ; P & lt; 0.001 comparing 2001 and 2008); adjusted AC usage rates were constant from 2004 (35.2%) to 2008 (36.4%; P = 0.43 for trend). Surgical ICUs used both catheters most often (unadjusted rates, ACs: 56.0% of patients vs. 22.4% in medical and 32.6% in combined units, P & lt; 0.001; CVCs: 46.9% vs. 32.5% and 36.4%, P & lt; 0.001). There was a wide variability in AC use across ICUs in patients receiving mechanical ventilation (median [interquartile range], 49.2% [29.9–72.3%] ; adjusted median odds ratio [AMOR], 2.56), vasopressors (51.7% [30.8–76.2%] ; AMOR, 2.64), and with predicted mortality of 2% or less (31.7% [19.5–49.3%]; AMOR, 1.94). There was less variability in CVC use (mechanical ventilation: 63.4% [54.9–72.9%] , AMOR, 1.69; vasopressors: 71.4% (59.5–85.7%), AMOR, 1.93; predicted mortality of 2% or less: 18.7% (11.9–27.3%), AMOR, 1.90). Conclusions: Both ACs and CVCs are common in ICU patients. There is more variation in use of ACs than CVCs.
    Type of Medium: Online Resource
    ISSN: 0003-3022
    URL: Article
    DOI: 10.1097/ALN.0000000000000008
    RVK:
    XA 22600
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
    detail.hit.zdb_id: 2016092-6
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  • 4
    Online Resource
    Online Resource
    Association Between Arterial Catheter Use and Hospital Mortality in Intensive Care Units
    American Medical Association (AMA) ; 2014
    In:  JAMA Internal Medicine Vol. 174, No. 11 ( 2014-11-01), p. 1746-
    Details
    In: JAMA Internal Medicine, American Medical Association (AMA), Vol. 174, No. 11 ( 2014-11-01), p. 1746-
    Type of Medium: Online Resource
    ISSN: 2168-6106
    URL: Article
    DOI: 10.1001/jamainternmed.2014.3297
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2014
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  • 5
    Online Resource
    Online Resource
    Association of patient-to-intensivist ratio with hospital mortality in Australia and New Zealand
    Springer Science and Business Media LLC ; 2022
    In:  Intensive Care Medicine Vol. 48, No. 2 ( 2022-02), p. 179-189
    Details
    In: Intensive Care Medicine, Springer Science and Business Media LLC, Vol. 48, No. 2 ( 2022-02), p. 179-189
    Type of Medium: Online Resource
    ISSN: 0342-4642 , 1432-1238
    URL: Article
    DOI: 10.1007/s00134-021-06575-z
    RVK:
    XA 10000
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 1459201-0
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  • 6
    Online Resource
    Online Resource
    Variation in Bed-to-Physician Ratios During Weekday Daytime Hours in ICUs in Australia and New Zealand*
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Critical Care Medicine Vol. 50, No. 12 ( 2022-12), p. 1737-1747
    Details
    In: Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. 12 ( 2022-12), p. 1737-1747
    Abstract: To determine common “bed-to-physician” ratios during weekday hours across ICUs and assess factors associated with variability in this ratio. DESIGN: Retrospective cohort study. SETTING: All ICUs in Australia/New Zealand that participated in a staffing survey administered in 2017–2018. PATIENTS: ICU admissions from 2016 to 2018. METHODS: We linked survey data with patient-level data. We defined: 1) bed-to-intensivist ratio as the number of usually available ICU beds divided by the number of onsite weekday daytime intensivists; and 2) bed-to-physician ratio as the number of available ICU beds divided by the total number of physicians (intensivists + nonintensivists, including trainees). We calculated the median and interquartile range (IQR) of bed-to-intensivist ratio and bed-to-physician ratios during weekday hours. We assessed variability in each by type of hospital and ICU and by severity of illness of patients, defined by the predicted hospital mortality. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Of the 123 (87.2%) of Australia/New Zealand ICUs that returned staffing surveys, 114 (92.7%) had an intensivist present during weekday daytime hours, and 116 (94.3%) reported at least one nonintensivist physician. The median bed-to-intensivist ratio was 8.0 (IQR, 6.0–11.4), which decreased to a bed-to-physician ratio of 3.0 (IQR, 2.2–4.9). These ratios varied with mean severity of illness of the patients in the unit. The median bed-to-intensivist ratio was highest (13.5) for ICUs with a mean predicted mortality 〉 2–4%, and the median bed-to-physician ratio was highest (5.7) for ICUs with a mean predicted mortality of 〉 4–6%. Both ratios decreased and plateaued in ICUs with a mean predicted mortality for patients greater than 8% (median bed-to-intensivist ratio range, 6.8–8.0, and bed-to-physician ratio range of 2.4–2.7). CONCLUSIONS: Weekday bed-to-physician ratios in Australia/New Zealand ICUs are lower than the bed-to-intensivist ratios and have a relatively fixed ratio of less than 3 for units taking care of patients with a higher average severity of illness. These relationships may be different in other countries or healthcare systems.
    Type of Medium: Online Resource
    ISSN: 0090-3493
    URL: Article
    DOI: 10.1097/CCM.0000000000005623
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 2034247-0
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