TY - JOUR
T1 - Intensive care unit physician staffing is associated with decreased length of stay, hospital cost, and complications after esophageal resection
AU - Dimick, Justin B.
AU - Pronovost, Peter J.
AU - Heitmiller, Richard F.
AU - Lipsett, Pamela A.
PY - 2001
Y1 - 2001
N2 - Objective: To determine whether having daily rounds by an intensive care unit (ICU) physician is associated with clinical and economic outcomes after esophageal resection. Design: ICU information was obtained from a prospective survey and linked to retrospective patient data from the Maryland Health Services Cost Review Commission. The main outcome variables were in-hospital mortality rate, length of stay, hospital cost, and complications after esophageal resection. Setting: Nonfederal acute care hospitals in Maryland that performed esophageal resection (n = 35 hospitals) during the study period, 1994-1998. Patients: Adult patients who underwent esophageal resection in Maryland (n = 366 patients) from 1994 to 1998. Interventions: Presence vs. absence of daily rounds by an ICU physician. Measurements and Main Results: After adjusting for patient case-mix and other hospital characteristics, lack of daily rounds by an ICU physician was independently associated with a 73% increase in hospital length of stay (7 days; 95% confidence interval [CI], 1-15; p = .012) and a 61% increase in total hospital cost ($8,839; 95% CI, $1,674-$19,192; p = .013), but there was no association with in-hospital mortality rate. In addition, the following postoperative complications were independently associated with lack of daily rounds by an ICU physician: pulmonary insufficiency (odds ratio [OR], 4.0; CI, 1.4-11.0), renal failure (OR, 6.3; CI, 1.4-28.7), aspiration (OR, 1.7; CI, 1.0-2.8), and reintubation (OR, 2.8; CI, 1.5-5.2). Conclusions: Having daily rounds by an ICU physician is associated with shorter lengths of stay, lower hospital cost, and decreased frequency of postoperative complications after esophageal resection. Healthcare providers and policymakers should use this information to help improve quality of care and reduce costs for patients undergoing high-risk surgical procedures.
AB - Objective: To determine whether having daily rounds by an intensive care unit (ICU) physician is associated with clinical and economic outcomes after esophageal resection. Design: ICU information was obtained from a prospective survey and linked to retrospective patient data from the Maryland Health Services Cost Review Commission. The main outcome variables were in-hospital mortality rate, length of stay, hospital cost, and complications after esophageal resection. Setting: Nonfederal acute care hospitals in Maryland that performed esophageal resection (n = 35 hospitals) during the study period, 1994-1998. Patients: Adult patients who underwent esophageal resection in Maryland (n = 366 patients) from 1994 to 1998. Interventions: Presence vs. absence of daily rounds by an ICU physician. Measurements and Main Results: After adjusting for patient case-mix and other hospital characteristics, lack of daily rounds by an ICU physician was independently associated with a 73% increase in hospital length of stay (7 days; 95% confidence interval [CI], 1-15; p = .012) and a 61% increase in total hospital cost ($8,839; 95% CI, $1,674-$19,192; p = .013), but there was no association with in-hospital mortality rate. In addition, the following postoperative complications were independently associated with lack of daily rounds by an ICU physician: pulmonary insufficiency (odds ratio [OR], 4.0; CI, 1.4-11.0), renal failure (OR, 6.3; CI, 1.4-28.7), aspiration (OR, 1.7; CI, 1.0-2.8), and reintubation (OR, 2.8; CI, 1.5-5.2). Conclusions: Having daily rounds by an ICU physician is associated with shorter lengths of stay, lower hospital cost, and decreased frequency of postoperative complications after esophageal resection. Healthcare providers and policymakers should use this information to help improve quality of care and reduce costs for patients undergoing high-risk surgical procedures.
KW - Administration
KW - Critical care
KW - Economic
KW - Esophageal diseases
KW - Esophagectomy
KW - Intensive car
KW - Length of star
KW - Organization
KW - Postoperative care
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=0035054207&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0035054207&partnerID=8YFLogxK
U2 - 10.1097/00003246-200104000-00012
DO - 10.1097/00003246-200104000-00012
M3 - Article
C2 - 11373463
AN - SCOPUS:0035054207
SN - 0090-3493
VL - 29
SP - 753
EP - 758
JO - Critical care medicine
JF - Critical care medicine
IS - 4
ER -