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October 19, 1984, Vol 252, No. 15 >
ARTICLE | October 19, 1984

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

Theodore C. M. Li, MD; Malcolm C. Phillips, MD; Linda Shaw, MPH; E. Francis Cook, ScD; Charles Natanson, MD; Lee Goldman, MD, MPH
[+] Author Affiliations

Reprint requests to Division of Internal Medicine, Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (Dr Li).


JAMA. 1984;252(15):2023-2027. doi:10.1001/jama.1984.03350150023014
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References

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)

REFERENCES

1 +
Hospital Statistics: 1980 Edition . Chicago, American Hospital Association, 1980;.
2 +
Detsky AS, Stricker SC, Mulley AG, et al:  Prognosis, survival, and the expenditure of hospital resources for patients in an intensive care unit . N Engl J Med 1981;;305:667-672.
3 +
Thibault GE Mulley AG, Barnett GO, et al:  Medical intensive care: Indications, interventions, and outcomes . N Engl J Med 1980;;302:938-942.
4 +
Zook CJ, Moore FD:  High-cost users of medical care . N Engl J Med 1980;;302:996-1002.
5 +
Schroeder SA, Showstack JA, Roberts HE:  Frequency and clinical description of high-cost patients in 17 acute-care hospitals . N Engl J Med 1979;;300:1306-1309.
6 +
Knaus WA, Wagner DP, Draper EA, et al:  The range of intensive care services today . JAMA 1981;;246:2711-2716.
7 +
Cullen DJ:  Results and costs of intensive care . Anesthesiology 1977;;47:203-216.
8 +
Mulley AG, Thibault GE, Hughes RA, et al:  The course of patients with suspected myocardial infarction: The identification of low-risk patients for early transfer from intensive care . N Engl J Med 1980;;302:943-948.
9 +
Knaus WA, Draper EA, Wagner DP, et al:  Evaluating outcome from intensive care: A preliminary multihospital comparison . Crit Care Med 1982;;10:491-496.
10 +
Draper EA, Wagner DP, Knaus WA:  The use of intensive care: A comparison of a university and community hospital . Health Care Financing Rev 1981;;3:49-64.
11 +
Reinhardt PS (ed): SAS Supplemental Library User's Guide, 1980 . Cary, NC, SAS Institute, 1980;.
12 +
Breiman L, Freidman JH, Olshen RA, et al: Classification and Regression Trees . Belmont, Calif, Wadsworth Pub Co, 1984;.
13 +
Mantel N, Haenszel W:  Statistical aspects of the analysis of data from retrospective studies of disease . JNCI 1959;;22:719-748.
14 +
Russell LB: Technology in Hospitals: Medical Advances and Their Diffusion . Washington, DC, Brookings Institute, 1979;.
15 +
Teres D, Brown RB, Lemeshow S:  Predicting mortality of intensive care unit patients— the importance of coma . Crit Care Med 1982;; 10:86-95.
16 +
Cullen DJ, Ferrara LC, Briggs BA, et al:  Survival, hospitalization charges and follow-up results in critically ill patients . N Engl J Med 1976;;294:982-987.
17 +
Cooper R, Stamler J, Dyer A, et al:  The decline in mortality from coronary heart disease, U.S.A., 1968-1975 . J Chronic Dis 1978;; 31:709-719.
18 +
Gillum RF, Folsom A, Luepker RV, et al:  Sudden death and acute myocardial infarction in a metropolitan area, 1970-1980, the Minnesota heart survey . N Engl J Med 1983;;309:1353-1358.
19 +
Goldman L, Cook F, Hashimoto B, et al:  Evidence that hospital care for acute myocardial infarction has not contributed to the decline in coronary mortality between 1973-1974 and 1978-1979 . Circulation 1982;;65:936-942.
20 +
Cullen DJ, Civetta JM, Briggs BA, et al:  Therapeutic intervention scoring system: A method for quantitative comparison of patient care . Crit Care Med 1974;;2:57-60.
21 +
Knaus WA, Zimmerman JE, Wagner DP, et al:  APACHE-acute physiology and chronic health evaluation: A physiologically based classification system . Crit Care Med 1981;;9:591-597.
22 +
Taggee GF, Salness G, Thams J, et al:  Experience with a multidisciplinary critical care center in a community hospital . Crit Care Med 1975;;3:231-237.
23 +
Brown RS:  Hemodynamic monitoring in the community hospital ICU . Crit Care Med 1977;;5:101-104.
24 +
Safar P, Grenvik A:  Organization and physician education in critical care medicine . Anesthesiology 1977;;47:82-95.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Hospital Statistics: 1980 Edition . Chicago, American Hospital Association, 1980;.
2 +
Detsky AS, Stricker SC, Mulley AG, et al:  Prognosis, survival, and the expenditure of hospital resources for patients in an intensive care unit . N Engl J Med 1981;;305:667-672.
3 +
Thibault GE Mulley AG, Barnett GO, et al:  Medical intensive care: Indications, interventions, and outcomes . N Engl J Med 1980;;302:938-942.
4 +
Zook CJ, Moore FD:  High-cost users of medical care . N Engl J Med 1980;;302:996-1002.
5 +
Schroeder SA, Showstack JA, Roberts HE:  Frequency and clinical description of high-cost patients in 17 acute-care hospitals . N Engl J Med 1979;;300:1306-1309.
6 +
Knaus WA, Wagner DP, Draper EA, et al:  The range of intensive care services today . JAMA 1981;;246:2711-2716.
7 +
Cullen DJ:  Results and costs of intensive care . Anesthesiology 1977;;47:203-216.
8 +
Mulley AG, Thibault GE, Hughes RA, et al:  The course of patients with suspected myocardial infarction: The identification of low-risk patients for early transfer from intensive care . N Engl J Med 1980;;302:943-948.
9 +
Knaus WA, Draper EA, Wagner DP, et al:  Evaluating outcome from intensive care: A preliminary multihospital comparison . Crit Care Med 1982;;10:491-496.
10 +
Draper EA, Wagner DP, Knaus WA:  The use of intensive care: A comparison of a university and community hospital . Health Care Financing Rev 1981;;3:49-64.
11 +
Reinhardt PS (ed): SAS Supplemental Library User's Guide, 1980 . Cary, NC, SAS Institute, 1980;.
12 +
Breiman L, Freidman JH, Olshen RA, et al: Classification and Regression Trees . Belmont, Calif, Wadsworth Pub Co, 1984;.
13 +
Mantel N, Haenszel W:  Statistical aspects of the analysis of data from retrospective studies of disease . JNCI 1959;;22:719-748.
14 +
Russell LB: Technology in Hospitals: Medical Advances and Their Diffusion . Washington, DC, Brookings Institute, 1979;.
15 +
Teres D, Brown RB, Lemeshow S:  Predicting mortality of intensive care unit patients— the importance of coma . Crit Care Med 1982;; 10:86-95.
16 +
Cullen DJ, Ferrara LC, Briggs BA, et al:  Survival, hospitalization charges and follow-up results in critically ill patients . N Engl J Med 1976;;294:982-987.
17 +
Cooper R, Stamler J, Dyer A, et al:  The decline in mortality from coronary heart disease, U.S.A., 1968-1975 . J Chronic Dis 1978;; 31:709-719.
18 +
Gillum RF, Folsom A, Luepker RV, et al:  Sudden death and acute myocardial infarction in a metropolitan area, 1970-1980, the Minnesota heart survey . N Engl J Med 1983;;309:1353-1358.
19 +
Goldman L, Cook F, Hashimoto B, et al:  Evidence that hospital care for acute myocardial infarction has not contributed to the decline in coronary mortality between 1973-1974 and 1978-1979 . Circulation 1982;;65:936-942.
20 +
Cullen DJ, Civetta JM, Briggs BA, et al:  Therapeutic intervention scoring system: A method for quantitative comparison of patient care . Crit Care Med 1974;;2:57-60.
21 +
Knaus WA, Zimmerman JE, Wagner DP, et al:  APACHE-acute physiology and chronic health evaluation: A physiologically based classification system . Crit Care Med 1981;;9:591-597.
22 +
Taggee GF, Salness G, Thams J, et al:  Experience with a multidisciplinary critical care center in a community hospital . Crit Care Med 1975;;3:231-237.
23 +
Brown RS:  Hemodynamic monitoring in the community hospital ICU . Crit Care Med 1977;;5:101-104.
24 +
Safar P, Grenvik A:  Organization and physician education in critical care medicine . Anesthesiology 1977;;47:82-95.

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