Division of Critical Care Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York.
Intensive Care National Audit & Research Centre, Napier House, London, United Kingdom.
JAMA Intern Med. 2017 Mar 1;177(3):388-396. doi: 10.1001/jamainternmed.2016.8457.
The patient-to-intensivist ratio (PIR) across intensive care units (ICUs) is not standardized and the association of PIR with patient outcome is not well established. Understanding the impact of PIR on outcomes is necessary to optimize senior medical staffing and deliver high-quality care.
To test the hypotheses that: (1) there is significant variation in the PIR across ICUs and (2) higher PIRs are associated with higher hospital mortality for ICU patients.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort analysis of patients (≥16 years) admitted to ICUs staffed by a single intensivist during daytime hours in the United Kingdom from 2010 to 2013.
Patient-to-intensivist ratios, which we defined for each patient as the number of patients cared for by the intensivist each day averaged over the patient's stay.
Using standard summary statistics, we evaluated PIR variation across ICUs. We used multivariable, mixed-effect, logistic regression analysis to evaluate the association between PIR and hospital mortality at ultimate discharge from acute hospital (primary outcome) and at ICU discharge.
Among 49 686 adults in 94 ICUs, median age was 66 (interquartile range [IQR], 52-76) years, and 45.1% were women. The ultimate hospital mortality was 25.7%. The median PIR for patients was 8.5 (IQR, 6.9-10.8; full range, 1.0-23.5), and varied substantially among individual ICUs. The association between PIR and ultimate hospital mortality was U-shaped; there was a reduction in the odds of mortality associated with an increasing PIR up to 7.5 after which the odds of mortality increased again significantly (average patient mortality for lowest PIR, 22%; PIR of 7.5, 15%; highest PIR, 19%; P = .003). A similar U-shaped association was seen for PIR and mortality in the ICU (nadir of mortality at a PIR of 7.8, P < .001).
PIR varied across UK ICUs. The optimal PIR in this cohort of UK ICU patients was 7.5, with significantly increased ICU and hospital mortality above and below this ratio. The number of patients cared for by 1 intensivist may impact patient outcomes.
重症监护病房（ICU）之间的患者与重症监护医生的比例（PIR）没有标准化，且 PIR 与患者预后的关系尚未得到很好的确定。了解 PIR 对结果的影响对于优化高级医疗人员配置和提供高质量的护理是必要的。
检验以下假设：（1）各 ICU 之间的 PIR 存在显著差异；（2）较高的 PIR 与 ICU 患者的住院死亡率较高相关。
设计、地点和参与者：这是一项对 2010 年至 2013 年期间在英国白天由一名主治医生负责的 ICU 收治的患者（年龄≥16 岁）进行的回顾性队列分析。
我们将患者的 PIR 定义为每位患者每天由主治医生照顾的患者人数，平均值为患者的住院时间。
我们使用标准的汇总统计数据评估了 ICU 之间的 PIR 差异。我们使用多变量、混合效应、逻辑回归分析评估了 PIR 与急性医院（主要结局）和 ICU 出院时的住院死亡率之间的关联。
在 94 个 ICU 的 49686 名成年人中，中位年龄为 66 岁（四分位距[IQR]，52-76 岁），45.1%为女性。最终的医院死亡率为 25.7%。患者的中位 PIR 为 8.5（IQR，6.9-10.8；全范围，1.0-23.5），且在各个 ICU 之间差异很大。PIR 与最终医院死亡率之间呈 U 形关系；随着 PIR 的增加，死亡率的几率逐渐降低，直到 PIR 达到 7.5，之后死亡率的几率再次显著增加（最低 PIR 组的平均患者死亡率为 22%；PIR 为 7.5 时为 15%；最高 PIR 时为 19%；P=0.003）。在 ICU 中，PIR 与死亡率之间也存在类似的 U 形关联（死亡率的最低值出现在 PIR 为 7.8 时，P<0.001）。
英国 ICU 之间的 PIR 存在差异。在该队列中，英国 ICU 患者的最佳 PIR 为 7.5，在此比值以上和以下，ICU 和医院死亡率显著增加。1 名主治医生照顾的患者人数可能会影响患者的结局。
