Impact of 24-hour in-house intensivists on a dedicated cardiac surgery intensive care unit.

Full Abstract

BACKGROUND: Intensive care unit (ICU) physician staffing models for cardiac surgery patients vary widely and correlate poorly with outcomes. Clinical outcomes associated with 24-hour, in-house intensivists working in a dedicated post-cardiac surgical unit has not been previously investigated. We sought to examine the safety and efficacy of such a model. METHODS: A retrospective, propensity-matched, cohort study of all patients undergoing a cardiac surgical procedure at a single tertiary center was performed. The control cohort (n = 1,467) consisted of patients admitted to the traditional, mixed surgical intensive care unit (SICU) from January 2005 to January 2007. The intervention cohort (n = 1,089) consisted of patients admitted to a newly created "hybrid" cardiac surgery ICU (CICU) from January 2007 to January 2008, which was staffed by 24-hour in-house consultant intensivists and a daytime, fast track cardiac anesthesiologist. The primary outcomes were blood product utilization, requirement for ventilation, and ICU recidivism. RESULTS: The proportion of patients in the CICU cohort who received transfused red blood cells was decreased compared with the SICU cohort (30.2% versus 42.3%, p < 0.001). Similar reductions in platelets and fresh frozen plasma were also observed. The CICU patients were less likely to arrive to the ICU intubated (43.7% versus 66.5%, p < 0.001). There were no differences in postoperative complications. Overall hospital length of stay was reduced in the CICU cohort by a median of 1 day (6 days [interquartile range, 5 to 8] versus 7 days [5 to 9], p < 0.001). Significant reductions in mortality and ICU recidivism were not observed. CONCLUSIONS: The current Manitoba CICU model of 24-hour intensive care physician/cardiac anesthesiologist staffing in postoperative cardiac surgery care is associated with reduced transfusion of blood components, decreased requirement for mechanical ventilation, and shorter hospital length of stay.

Author information

Author/s: Kumar, Kanwal (K); Zarychanski, Ryan (R); Bell, Dean D (DD); Manji, Rizwan (R); Zivot, Joel (J); Menkis, Alan H (AH); Arora, Rakesh C (RC); Cardiovascular Health Research in Manitoba Investigator Group;

Affiliation: Cardiovascular Health Research in Manitoba Investigator Group, Cardiac Sciences Program, St Boniface General Hospital/IH Asper Clinical Research Institute, Winnipeg, Manitoba, Canada.

Journal and publication information

Publication Type: Comparative Study; Journal Article

Journal: The Annals of thoracic surgery (Ann Thorac Surg), published in Netherlands. (Language: eng)

Reference: 2009-Oct; vol 88 (issue 4) : pp 1153-61

Dates: Created 2009/09/21; Completed 2009/10/08;

PMID: 19766800, status: MEDLINE (last retrieval date: 10/8/2009, IMS Date: )

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