Gershengorn Hayley B, Xu Yunchao, Chan Carri W, Armony Mor, Gong Michelle N
Division of Critical Care Medicine and Department of Neurology; Albert Einstein College of Medicine, Montefiore Medical Center; Bronx, New York, United States of America.
Department of Information, Operations, and Management Sciences; New York University Stern School of Business; New York, New York, United States of America.
PLoS One. 2016 Dec 12;11(12):e0167959. doi: 10.1371/journal.pone.0167959. eCollection 2016.
Hospitals are increasingly using critical care outreach teams (CCOTs) to respond to patients deteriorating outside intensive care units (ICUs). CCOT staffing is variable across hospitals and optimal team composition is unknown.
To assess whether adding a critical care medicine trained physician assistant (CCM-PA) to a critical care outreach team (CCOT) impacts clinical and process outcomes.
We performed a retrospective study of two cohorts-one with a CCM-PA added to the CCOT (intervention hospital) and one with no staffing change (control hospital)-at two facilities in the same system. All adults in the emergency department and hospital for whom CCOT consultation was requested from October 1, 2012-March 16, 2013 (pre-intervention) and January 5-March 31, 2014 (post-intervention) were included. We performed difference-in-differences analyses comparing pre- to post-intervention periods in the intervention versus control hospitals to assess the impact of adding the CCM-PA to the CCOT.
Our cohort consisted of 3,099 patients (control hospital: 792 pre- and 595 post-intervention; intervention hospital: 1114 pre- and 839 post-intervention). Intervention hospital patients tended to be younger, with fewer comorbidities, but with similar severity of acute illness. Across both periods, hospital mortality (p = 0.26) and hospital length of stay (p = 0.64) for the intervention vs control hospitals were similar, but time-to-transfer to the ICU was longer for the intervention hospital (13.3-17.0 vs 11.5-11.6 hours, p = 0.006). Using the difference-in-differences approach, we found a 19.2% reduction (95 confidence interval: 6.7%-31.6%, p = 0.002) in the time-to-transfer to the ICU associated with adding the CCM-PA to the CCOT; we found no difference in hospital mortality (p = 0.20) or length of stay (p = 0.52).
Adding a CCM-PA to the CCOT was associated with a notable reduction in time-to-transfer to the ICU; hospital mortality and length of stay were not impacted.
医院越来越多地使用重症监护外展团队（CCOTs）来应对重症监护病房（ICUs）以外病情恶化的患者。不同医院的CCOT人员配置各不相同，最佳团队组成尚不清楚。
评估在重症监护外展团队（CCOT）中增加一名经过重症医学培训的医师助理（CCM-PA）是否会影响临床和流程结果。
我们对同一系统内两家机构的两个队列进行了回顾性研究，一个队列在CCOT中增加了CCM-PA（干预医院），另一个队列人员配置无变化（对照医院）。纳入了2012年10月1日至2013年3月16日（干预前）以及2014年1月5日至3月31日（干预后）期间急诊科和医院中所有被要求CCOT会诊的成年人。我们进行了差分分析，比较干预医院和对照医院干预前后的时间段，以评估在CCOT中增加CCM-PA的影响。
我们的队列包括3099名患者（对照医院：干预前792例，干预后595例；干预医院：干预前1114例，干预后839例）。干预医院的患者往往更年轻，合并症更少，但急性疾病严重程度相似。在两个时间段内，干预医院和对照医院的医院死亡率（p = 0.26）和住院时间（p = 0.64）相似，但干预医院患者转入ICU的时间更长（13.3 - 17.0小时对11.5 - 11.6小时，p = 0.006）。使用差分法，我们发现与在CCOT中增加CCM-PA相关的转入ICU时间减少了19.2%（95%置信区间：6.7% - 31.6%，p = 0.002）；我们发现医院死亡率（p = 0.20）或住院时间（p = 0.52）没有差异。
在CCOT中增加CCM-PA与转入ICU的时间显著减少相关；医院死亡率和住院时间未受影响。
