连续工作的重症医学专家天数与危重症患者结局的关联。

Association Between Consecutive Days Worked by Intensivists and Outcomes for Critically Ill Patients.

机构信息

Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL.

Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, NY.

出版信息

Crit Care Med. 2020 Apr;48(4):594-598. doi: 10.1097/CCM.0000000000004202.

DOI:10.1097/CCM.0000000000004202

PMID:32205608

Abstract

OBJECTIVE

To evaluate the association between consecutive days worked by intensivists and ICU patient outcomes.

DESIGN

Retrospective cohort study linked with survey data.

SETTING

Australia and New Zealand ICUs.

PATIENTS

Adults (16+ yr old) admitted to ICU in the Australia New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation Registries (July 1, 2016, to June 30, 2018).

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

We linked data on staffing schedules for each unit from the Critical Care Resources Registry 2016-2017 annual survey with patient-level data from the Adult Patient Database. The a priori chosen primary outcome was ICU length of stay. Secondary outcomes included hospital length of stay, ICU readmissions, and mortality (ICU and hospital). We used multilevel multivariable regression modeling to assess the association between days of consecutive intensivist service and patient outcomes; the predicted probability of death was included as a covariate and individual ICU as a random effect. The cohort included 225,034 patients in 109 ICUs. Intensivists were scheduled for seven or more consecutive days in 43 (39.4%) ICUs; 27 (24.7%) scheduled intensivists for 5 days, 22 (20.1%) for 4 days, seven (6.4%) for 3 days, four (3.7%) for 2 days, and six (5.5%) for less than or equal to 1 day. Compared with care by intensivists working 7+ consecutive days (adjusted ICU length of stay = 2.85 d), care by an intensivist working 3 or fewer consecutive days was associated with shorter ICU length of stay (3 consecutive days: 0.46 d fewer, p = 0.010; 2 consecutive days: 0.77 d fewer, p < 0.001; ≤ 1 consecutive days: 0.68 d fewer, p < 0.001). Shorter schedules of consecutive intensivist days worked were also associated with trends toward shorter hospital length of stay without increases in ICU readmissions or hospital mortality.

CONCLUSIONS

Care by intensivists working fewer consecutive days is associated with reduced ICU length of stay without negatively impacting mortality.

摘要

目的

评估连续工作天数与 ICU 患者结局的关联。

设计

回顾性队列研究与调查数据相结合。

地点

澳大利亚和新西兰 ICU。

患者

在澳大利亚新西兰重症监护学会中心进行的预后和资源评估登记处（2016 年 7 月 1 日至 2018 年 6 月 30 日）入住 ICU 的成年人（≥16 岁）。

干预措施

无。

测量和主要结果

我们从 2016-2017 年重症监护资源登记年度调查中获取每个单位人员配备计划的数据，并将其与成人患者数据库中的患者水平数据相链接。预先选择的主要结局是 ICU 住院时间。次要结局包括住院时间、ICU 再入院和死亡率（ICU 和医院）。我们使用多水平多变量回归模型评估连续天数与患者结局之间的关联；将死亡的预测概率作为协变量，并将个体 ICU 作为随机效应。该队列包括 109 个 ICU 中的 225034 名患者。43 个 ICU（39.4%）安排了 7 天或以上的连续 intensivist；27 个 ICU（24.7%）安排了 intensivist 5 天，22 个 ICU（20.1%）安排了 intensivist 4 天，7 个 ICU（6.4%）安排了 intensivist 3 天，4 个 ICU（3.7%）安排了 intensivist 2 天，6 个 ICU（5.5%）安排了 intensivist 1 天或以下。与连续工作 7 天以上的 intensivist 护理相比（调整后的 ICU 住院时间=2.85 天），连续工作 3 天或更少的 intensivist 护理与 ICU 住院时间较短相关（连续工作 3 天：少 0.46 天，p=0.010；连续工作 2 天：少 0.77 天，p<0.001；连续工作≤1 天：少 0.68 天，p<0.001）。连续 intensivist 工作天数较短的方案也与住院时间缩短的趋势相关，而 ICU 再入院或医院死亡率没有增加。