Survey of Contemporary Cardiac Surgery Intensive Care Unit Models in the United States

The Society of Thoracic Surgeons Workforce for Critical Care (STS WFCC)

Research output: Contribution to journalArticle

Abstract

Background: Intensive care unit (ICU) structure and intensive care physician staffing (IPS) models are thought to influence outcomes after cardiac surgery. Given limited information on staffing in the cardiothoracic ICU, The Society of Thoracic Surgeons Workforce on Critical Care undertook a survey to describe current IPS models. We hypothesized that variability would exist throughout the United States. Methods: A survey was sent to The Society of Thoracic Surgeons centers in the United States. Center case volume, ICU census, procedure profiles, and the primary specialties of consultants were queried. Definitions of IPS models were open (managed by cardiac surgeons), closed (all decisions made by dedicated intensivists 7 days a week), or semiopen (intensivist attends 5-7 days a week with surgeons cosharing management). Experience level of bedside providers and after-hours provider coverage were also assessed. Results: Of the 965 centers contacted, 148 (15.3%) completed surveys. Approximately 41% of reporting centers used a dedicated cardiothoracic ICU for immediate postoperative management. The most common IPS model was open (47%), followed by semiopen (41%) and closed (12%). The primary specialties of intensivists varied, with pulmonary medicine/critical care being predominant (67%). Physician assistants were the most common after-hours provider (44%). More than one-third of responding centers described having no house staff, other than bedside nurses, for nighttime coverage. Conclusions: Cardiothoracic ICU models vary widely in the United States, with almost half being open, often with no in-house coverage. In-house nighttime coverage was (1) not driven by case complexity and (2) most commonly provided by a physician assistant. Clinical outcomes associated with different ISPS models require further evaluation.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Critical Care
Thoracic Surgery
Intensive Care Units
Physicians
Physician Assistants
Pulmonary Medicine
Censuses
Internship and Residency
Consultants
Surveys and Questionnaires
Nurses

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Survey of Contemporary Cardiac Surgery Intensive Care Unit Models in the United States. / The Society of Thoracic Surgeons Workforce for Critical Care (STS WFCC).

In: Annals of Thoracic Surgery, 01.01.2019.

Research output: Contribution to journalArticle

The Society of Thoracic Surgeons Workforce for Critical Care (STS WFCC). / Survey of Contemporary Cardiac Surgery Intensive Care Unit Models in the United States. In: Annals of Thoracic Surgery. 2019.
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title = "Survey of Contemporary Cardiac Surgery Intensive Care Unit Models in the United States",
abstract = "Background: Intensive care unit (ICU) structure and intensive care physician staffing (IPS) models are thought to influence outcomes after cardiac surgery. Given limited information on staffing in the cardiothoracic ICU, The Society of Thoracic Surgeons Workforce on Critical Care undertook a survey to describe current IPS models. We hypothesized that variability would exist throughout the United States. Methods: A survey was sent to The Society of Thoracic Surgeons centers in the United States. Center case volume, ICU census, procedure profiles, and the primary specialties of consultants were queried. Definitions of IPS models were open (managed by cardiac surgeons), closed (all decisions made by dedicated intensivists 7 days a week), or semiopen (intensivist attends 5-7 days a week with surgeons cosharing management). Experience level of bedside providers and after-hours provider coverage were also assessed. Results: Of the 965 centers contacted, 148 (15.3{\%}) completed surveys. Approximately 41{\%} of reporting centers used a dedicated cardiothoracic ICU for immediate postoperative management. The most common IPS model was open (47{\%}), followed by semiopen (41{\%}) and closed (12{\%}). The primary specialties of intensivists varied, with pulmonary medicine/critical care being predominant (67{\%}). Physician assistants were the most common after-hours provider (44{\%}). More than one-third of responding centers described having no house staff, other than bedside nurses, for nighttime coverage. Conclusions: Cardiothoracic ICU models vary widely in the United States, with almost half being open, often with no in-house coverage. In-house nighttime coverage was (1) not driven by case complexity and (2) most commonly provided by a physician assistant. Clinical outcomes associated with different ISPS models require further evaluation.",
author = "{The Society of Thoracic Surgeons Workforce for Critical Care (STS WFCC)} and Arora, {Rakesh C.} and Subhasis Chatterjee and Shake, {Jay G.} and Hitoshi Hirose and Engelman, {Dan T.} and Joseph Rabin and Michael Firstenberg and Moosdorf, {Rainer G.H.} and Geller, {Charles M.} and Brett Hiebert and Whitman, {Glenn J.}",
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AU - The Society of Thoracic Surgeons Workforce for Critical Care (STS WFCC)

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AU - Shake, Jay G.

AU - Hirose, Hitoshi

AU - Engelman, Dan T.

AU - Rabin, Joseph

AU - Firstenberg, Michael

AU - Moosdorf, Rainer G.H.

AU - Geller, Charles M.

AU - Hiebert, Brett

AU - Whitman, Glenn J.

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