Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Republic of Korea.
Medical Research Collaborating Center, Seoul National University Bundang Hospital, Republic of Korea.
J Crit Care. 2018 Aug;46:23-28. doi: 10.1016/j.jcrc.2018.04.001. Epub 2018 Apr 6.
Previous studies have found an increase in in-hospital mortality when trainee physicians rotate. Our retrospective cohort study investigated whether trainee physicians' turnover influenced 30-day mortality in Korean intensive care units (ICUs), which have high-intensity daytime intensivist coverage only on weekdays.
Participants were adults over 19years old admitted to ICUs in a Korean tertiary care academic hospital between 2012 and 2016. Demographic and clinical data were collected on admission, and dates of death recorded. The primary outcome was the association between ICU admission in the turnover periods (March and May) and 30-day mortality after admission to ICUs with high-intensity daytime intensivist coverage.
Overall, there was no significant correlation between ICU admission during turnover periods and 30-day mortality [hazard ratio (HR), 1.06; 95% confidence interval (CI), 0.83-1.35, P=0.647]; the same trend was found for ICU admissions when there was no intensivist coverage (HR: 1.24, 95% CI: 0.91-1.69, P=0.177).
We found no overall association between physician turnover and 30-day mortality of patients admitted to ICUs with high-intensity daytime intensivist coverage or with no intensivist coverage.
之前的研究发现，住院医师轮班时住院死亡率会增加。我们的回顾性队列研究调查了住院医师轮班是否会影响韩国重症监护病房（ICU）的 30 天死亡率，韩国 ICU 仅在工作日白天有高强度的主治医生覆盖。
参与者为 2012 年至 2016 年期间在韩国一家三级保健学术医院 ICU 住院的 19 岁以上成年人。入院时收集人口统计学和临床数据，并记录死亡日期。主要结局是 ICU 入住周转期（3 月和 5 月）与白天高强度主治医生覆盖的 ICU 入住后 30 天死亡率之间的相关性。
总体而言，在轮班期间入住 ICU 与 30 天死亡率之间没有显著相关性[危险比（HR），1.06；95%置信区间（CI），0.83-1.35，P=0.647]；当没有主治医生覆盖时，入住 ICU 也呈现出相同的趋势（HR：1.24，95% CI：0.91-1.69，P=0.177）。
我们发现，白天高强度主治医生覆盖或没有主治医生覆盖的 ICU 住院患者的医师轮班与 30 天死亡率之间没有总体关联。
