Association of care by a non-medical intensive care unit provider team with outcomes of medically critically ill patients
Journal of Critical Care(2022)
摘要
Objective
To determine the association of boarding of critically ill medical patients on non-medical intensive care unit (ICU) provider teams with outcomes.
Design
A retrospective cohort study.
Setting
ICUs in a tertiary academic medical center.
Patients
Patients with medical critical illness.
Interventions
None.
Measurement and main results
We compared outcomes for critically ill medical patients admitted to a non-medical specialty ICU team (April 1 – August 30, 2020) with those admitted to the medical ICU team (January 1, 2018 - March 31, 2020). The primary outcome was hospital mortality; secondary outcomes were hospital length of stay (LOS) and hospital disposition for survivors.Our cohort consisted of 1241 patients admitted to the medical ICU team and 230 admitted to non-medical ICU teams. Unadjusted hospital mortality (medical ICU, 38.8% vs non-medical ICU, 42.2%, p = 0.33) and hospital LOS (7.4 vs 7.4 days, p = 0.96) were similar between teams. Among survivors, more non-medical ICU team patients were discharged home (72.6% vs 82.0%, p = 0.024). After multivariable adjustment, we found no difference in mortality, LOS, or home discharge between teams. However, among hospital survivors, admission to a non-medical ICU team was associated with a longer LOS (regression coefficient [95% CI] for log-transformed hospital LOS: 0.23 [0.05,0.40], p = 0.022). Certain subgroups—patients aged 50–64 years (odds-ratio [95% CI]: 4.22 [1.84,9.65], p = 0.001), with ≤10 comorbidities (0–5: 2.78 (1.11,6.95], p = 0.029; 6–10: 6.61 [1.38,31.71], p = 0.018), without acute respiratory failure (1.97 [1.20,3.23], p = 0.008)—had higher mortality when admitted to non-medical ICU teams.
Conclusions
We found no association between admission to non-medical ICU team and mortality for medically critically ill patients. However, survivors experienced longer hospital LOS when admitted to non-medical ICU teams. Middle-aged patients, those with low comorbidity burden, and those without respiratory failure had higher mortality when admitted to non-medical ICU teams.
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关键词
Intensive care unit,Internal medicine,Patient care team,Mortality,Length of stay,Critical care outcomes
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