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Two Weeks Versus One Week of Maximal Patient-Intensivist Continuity for Adult Medical Intensive Care Patients: A Two-Center Target Trial Emulation.
Admon, Andrew J; Cohen-Mekelburg, Shirley; Opatrny, Megan; Lee, Kathleen T; Law, Anica C; Gershengorn, Hayley B; Valley, Thomas S; Prescott, Hallie C; Wiktor, Michael J; Neeluru, Jayashree; Cooke, Colin R; Weissman, Gary E.
Afiliación
  • Admon AJ; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
  • Cohen-Mekelburg S; Department of Epidemiology, University of Michigan School of Public Health, University of Michigan, Ann Arbor, MI.
  • Opatrny M; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.
  • Lee KT; Pulmonary Service, Medicine Service, LTC Charles S. Kettles VA Medical Center, Ann Arbor, MI.
  • Law AC; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.
  • Gershengorn HB; Division of Gastroenterology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
  • Valley TS; Gastroenterology Service, Medicine Service, LTC Charles S. Kettles VA Medical Center, Ann Arbor, MI.
  • Prescott HC; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
  • Wiktor MJ; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI.
  • Neeluru J; Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, MA.
  • Cooke CR; Richard A and Susan F Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA.
  • Weissman GE; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
Crit Care Med ; 52(9): 1323-1332, 2024 Sep 01.
Article en En | MEDLINE | ID: mdl-38713002
ABSTRACT

OBJECTIVES:

To compare outcomes for 2 weeks vs. 1 week of maximal patient-intensivist continuity in the ICU.

DESIGN:

Retrospective cohort study.

SETTING:

Two U.S. urban, teaching, medical ICUs where intensivists were scheduled for 2-week service blocks site A was in the Midwest and site B was in the Northeast. PATIENTS Patients 18 years old or older admitted to a study ICU between March 1, 2017, and February 28, 2020.

INTERVENTIONS:

None. MEASUREMENTS AND MAIN

RESULTS:

We applied target trial emulation to compare admission during an intensivist's first week (as a proxy for 2 wk of maximal continuity) vs. admission during their second week (as a proxy for 1 wk of maximal continuity). Outcomes included hospital mortality, ICU length of stay, and, for mechanically ventilated patients, duration of ventilation. Exploratory outcomes included imaging, echocardiogram, and consultation orders. We used inverse probability weighting to adjust for baseline differences and random-effects meta-analysis to calculate overall effect estimates. Among 2571 patients, 1254 were admitted during an intensivist's first week and 1317 were admitted during a second week. At sites A and B, hospital mortality rates were 25.8% and 24.2%, median ICU length of stay were 4 and 2 days, and median mechanical ventilation durations were 3 and 3 days, respectively. There were no differences in adjusted mortality (odds ratio [OR], 1.01 [95% CI, 0.96-1.06]) or ICU length of stay (-0.25 d [-0.82 d to +0.32 d]) for 2 weeks vs. 1 week of maximal continuity. Among mechanically ventilated patients, there were no differences in adjusted mortality (OR, 1.00 [0.87-1.16]), ICU length of stay (+0.06 d [-0.78 d to +0.91 d]), or duration of mechanical ventilation (+0.37 d [-0.46 d to +1.21 d]) for 2 weeks vs. 1 week of maximal continuity.

CONCLUSIONS:

Two weeks of maximal patient-intensivist continuity was not associated with differences in clinical outcomes compared with 1 week in two medical ICUs.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Mortalidad Hospitalaria / Unidades de Cuidados Intensivos / Tiempo de Internación Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Crit Care Med Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Mortalidad Hospitalaria / Unidades de Cuidados Intensivos / Tiempo de Internación Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Crit Care Med Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos