Effects of a medical intensivist on patient care in a community teaching hospital.
To determine the effect of adding a trained intensivist on patient care and educational outcomes in a community teaching hospital..
Material and Methods
We retrospectively reviewed outcomes for patients admitted to the medical intensive-care unit (MICU) of a 270-bed community teaching hospital between July 1992 and June 1994.
Mortality rates and durations of stay were determined for the year before (BD, 1992 through 1993) and the first year after (AD, 1993 through 1994) introduction of a full-time director of critical care.
Performance of resident trainees on a standardized critical-care examination was measured for the same periods..
Overall, 459 patients in the BD period were compared with 471 patients in the AD period.
The mix of cases and severity of illness (acute physiology and chronic health evaluation or APACHE II scores) on admission were similar for the BD and AD periods.
MICU mortality decreased from 20.9% during the BD to 14.9% during the AD period (P=0.02), and in-hospital mortality decreased from 34.0% to 24.6% (P=0.002).
Disease-specific mortalities were lower during the AD period for most categories of illness.
Detailed analysis of a subgroup of patients (those with pneumonia) demonstrated no differences in distribution of patients by gender, race, or acuity of illness (APACHE II scores).
The mortality rate due to pneumonia decreased from 46% during the BD period to 31% during the AD period. (...)
Mots-clés Pascal : Unité soin intensif, Communauté, Centre hospitalier universitaire, Addition, Temps continu, Soin intensif, Analyse statistique, Relation médecin malade, Qualité vie, Pronostic, Homme, Réanimation, Organisation santé
Mots-clés Pascal anglais : Intensive care unit, Community, Teaching hospital, Addition, Continuous time, Intensive care, Statistical analysis, Physician patient relation, Quality of life, Prognosis, Human, Resuscitation, Public health organization
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0299662
Code Inist : 002B27B14C. Création : 15/07/1997.