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美国急症护理医院的重症监护医师。

Intensivists in U.S. Acute Care Hospitals.

机构信息

Critical Care Center, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.

Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.

出版信息

Crit Care Med. 2019 Apr;47(4):517-525. doi: 10.1097/CCM.0000000000003615.

Abstract

OBJECTIVES

To determine the total numbers of privileged and full-time equivalent intensivists in acute care hospitals with intensivists and compare the characteristics of hospitals with and without intensivists.

DESIGN

Retrospective analysis of the American Hospital Association Annual Survey Database (Fiscal Year 2015).

SETTING

Two-thousand eight-hundred fourteen acute care hospitals with ICU beds.

PATIENTS

None.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Of the 2,814 acute care hospitals studied, 1,469 (52%) had intensivists and 1,345 (48%) had no intensivists. There were 28,808 privileged and 19,996 full-time equivalent intensivists in the 1,469 hospitals with intensivists. In these hospitals, the median (25-75th percentile) numbers of privileged and full-time equivalent intensivists were 11 (5-24) and 7 (2-17), respectively. Compared with hospitals without intensivists, hospitals with privileged intensivists were primarily located in metropolitan areas (91% vs 50%; p < 0.001) and at the aggregate level had nearly thrice the number of hospital beds (403,522 [75%] vs 137,146 [25%]), 3.6 times the number of ICU beds (74,222 [78%] vs 20,615 [22%]), and almost twice as many ICUs (3,383 [65%] vs 1,846 [35%]). At the hospital level, hospitals with privileged intensivists had significantly more hospital beds (median, 213 vs 68; p < 0.0001), ICU beds (median, 32 vs 8; p < 0.0001), a higher ratio of ICU to hospital beds (15.6% vs 12.6%; p < 0.0001), and a higher number of ICUs per hospital (2 vs 1; p < 0.0001) than hospitals without intensivists.

CONCLUSIONS

Analyzing the intensivist section of the American Hospital Association Annual Survey database is a novel approach to estimating the numbers of privileged and full-time equivalent intensivists in acute care hospitals with ICU beds in the United States. This methodology opens the door to an enhanced understanding of the current supply and distribution of intensivists as well as future research into the intensivist workforce.

摘要

目的

确定有重症监护医师的急症护理医院中享有特权和全职当量的重症监护医师总数,并比较有和没有重症监护医师的医院的特征。

设计

对美国医院协会年度调查数据库(2015 财政年度)进行回顾性分析。

地点

2814 家设有 ICU 病床的急症护理医院。

患者

无。

干预措施

无。

测量和主要结果

在所研究的 2814 家急症护理医院中,有 1469 家(52%)有重症监护医师,1345 家(48%)没有重症监护医师。在有重症监护医师的 1469 家医院中,有 28808 名享有特权的和 19996 名全职当量的重症监护医师。在这些医院中,特权和全职当量重症监护医师的中位数(25%至 75%分位数)分别为 11(5 至 24)和 7(2 至 17)。与没有重症监护医师的医院相比,拥有特权重症监护医师的医院主要位于大都市地区(91%对 50%;p < 0.001),在综合层面上,医院床位数量几乎是后者的三倍(403522[75%]对 137146[25%]),重症监护病房床位数量是后者的三倍(74222[78%]对 20615[22%]),重症监护病房数量几乎是后者的两倍(3383[65%]对 1846[35%])。在医院层面上,拥有特权重症监护医师的医院床位(中位数,213 对 68;p < 0.0001)、重症监护病房床位(中位数,32 对 8;p < 0.0001)、重症监护病房与医院床位的比例(15.6%对 12.6%;p < 0.0001)和每所医院的重症监护病房数量(2 对 1;p < 0.0001)均显著高于没有重症监护医师的医院。

结论

分析美国医院协会年度调查数据库中的重症监护医师部分是一种估算美国设有 ICU 病床的急症护理医院中享有特权和全职当量重症监护医师数量的新方法。这种方法为更好地了解当前重症监护医师的供应和分布情况以及未来对重症监护医师劳动力的研究打开了大门。

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