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On-site Physician Staffing in a Community Hospital Intensive Care Unit:  Impact on Test and Procedure Use and on Patient Outcome

Theodore C. M. Li, MD; Malcolm C. Phillips, MD; Linda Shaw, MPH; E. Francis Cook, ScD; Charles Natanson, MD; Lee Goldman, MD, MPH
JAMA. 1984;252(15):2023-2027. doi:10.1001/jama.1984.03350150023014.
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To determine whether on-site physician staffing changed test and procedure use and improved patient outcome in a community hospital intensive care unit (ICU), we studied all ICU admissions for matched periods before and after the staffing change. Compared with the 463 year-1 patients, the 491 year-2 patients were no more likely to receive life-support interventions (respirators, dialysis, or pacemakers), but had substantially more monitoring interventions, such as pulmonary artery catheters (22% v 2%, P<.0001) and arterial catheters (9% v0%, P<.0001). After controlling for factors that predicted death (age, mental status at time of admission, reason for ICU admission), year-2 patients were significantly more likely to survive the ICU and subsequent hospital stay (P=.01). Nearly all of the improvement of survival rate took place among patients with intermediate likelihoods of death; this improved survival rate persisted at the 12-month follow-up (P=.01).

(JAMA 1984;252:2023-2027)

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