重症监护病房（ICU）持续强制配备现场顾问重症医学专家：对患者预后的影响

Continuous Mandatory Onsite Consultant Intensivists in the ICU: Impacts on Patient Outcomes.

作者信息

Baharoon Salim, Alyafi Walid, Tamim Hani, Al-Jahdali Hamdan, Alsafi Eman, Al-Sayyari Abdullah, Ahmed Qanta

机构信息

From the *King Saud bin Abdulaziz University for Health Sciences, Riyadh; †King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia; ‡Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon; §Quality Management, King Saud Chest Specialty Hospital, Riyadh, Professor of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; ∥Professor of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; and ¶Associate Professor, State University of New York, New York.

出版信息

J Patient Saf. 2016 Jun;12(2):108-13. doi: 10.1097/PTS.0000000000000097.

DOI:10.1097/PTS.0000000000000097

PMID:24618645

Abstract

OBJECTIVE

The aim of this study was to compare the impacts on patient outcomes of continuous versus on-demand access to certified consultant intensivists in the intensive care unit (ICU).

METHODS

Two general adult ICUs within the same health-care organization were compared in terms of patient outcomes. One unit featured continuous mandatory presence of a consultant intensivist (unit A), whereas the other had continuous access to a consultant intensivist during daytime hours but only on-demand access during the night-time hours (unit B). The data collected from these 2 units over the same 12-month period included sex, age, APACHE II score, disease category (medical, surgical, or traumatic), ICU mortality, and length of stay. A subgroup analysis was undertaken to assess the impact of disease severity, age, sex, and disease category on mortality.

RESULTS

When adjusted for disease severity, mortality was significantly lower in unit A with continuous mandatory 24-hour presence of a consultant intensivist compared with unit B with on-demand access to a consultant intensivist after working hours. Old age, female sex, and a higher APACHE II score were associated with poorer outcomes at both sites. The subgroup analysis revealed that the difference in mortality was only significant among medical patients but not among surgical or trauma patients.

CONCLUSIONS

An improved survival rate was observed only among medical patients admitted to the ICU with mandatory continuous access to a consultant intensivist, despite the presence of greater disease severity in the population admitted to this unit.

摘要

目的

本研究旨在比较重症监护病房（ICU）中持续配备与按需配备认证顾问重症医学专家对患者预后的影响。

方法

对同一医疗机构内的两个普通成人ICU的患者预后进行比较。一个科室有顾问重症医学专家持续强制在岗（A科室），而另一个科室白天有顾问重症医学专家随时可及，但夜间仅按需配备（B科室）。在同一12个月期间从这两个科室收集的数据包括性别、年龄、急性生理与慢性健康状况评分系统（APACHE II）评分、疾病类别（内科、外科或创伤性）、ICU死亡率和住院时间。进行亚组分析以评估疾病严重程度、年龄、性别和疾病类别对死亡率的影响。