Intensive cave unit physician staffing is associated with decreased lengthof stay, hospital cost, and complications after esophageal resection

Citation
Jb. Dimick et al., Intensive cave unit physician staffing is associated with decreased lengthof stay, hospital cost, and complications after esophageal resection, CRIT CARE M, 29(4), 2001, pp. 753-758
Citations number
20
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care
Journal title
CRITICAL CARE MEDICINE
ISSN journal
0090-3493 → ACNP
Volume
29
Issue
4
Year of publication
2001
Pages
753 - 758
Database
ISI
SICI code
0090-3493(200104)29:4<753:ICUPSI>2.0.ZU;2-7
Abstract
Objective: To determine whether having daily rounds by an intensive care un it (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 Cervices Cost Review C ommission. The main outcome variables were in-hospital mortality rate, leng th of stay, hospital cost, and complications after esophageal resection. Setting: Nonfederal acute care hospitals in Maryland that performed esophag eal 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 d aily rounds by an ICU physician. Measurements and Main Results:After adjusting for patient case-mix and othe r hospital characteristics, lack of daily rounds by an ICU physician was in dependently associated with a 73% increase in hospital length Of stay (7 da ys; 95% confidence interval [CI], 1-15; p = .012) and a 61% increase in tot al 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 dai ly 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 sho rter lengths of stay, lower hospital cost, and decreased frequency of posto perative complications after esophageal resection, Healthcare providers and policymakers should use this information to help improve quality of care a nd reduce costs for patients undergoing high-risk surgical procedures.