The impact of intensivists' base specialty of training on care process and outcomes of critically ill trauma patients

Abstract Background The care of the critically ill trauma patients is provided by intensivists with various base specialties of training. The purpose of this study was to investigate the impact of intensivists’ base specialty of training on the disparity of care process and patient outcome. Methods...

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Veröffentlicht in:The Journal of surgical research 2013-09, Vol.184 (1), p.577-581
Hauptverfasser: Matsushima, Kazuhide, MD, Goldwasser, Eleanor R., BA, Schaefer, Eric W., MS, Armen, Scott B., MD, Indeck, Matthew C., MD
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container_end_page 581
container_issue 1
container_start_page 577
container_title The Journal of surgical research
container_volume 184
creator Matsushima, Kazuhide, MD
Goldwasser, Eleanor R., BA
Schaefer, Eric W., MS
Armen, Scott B., MD
Indeck, Matthew C., MD
description Abstract Background The care of the critically ill trauma patients is provided by intensivists with various base specialties of training. The purpose of this study was to investigate the impact of intensivists’ base specialty of training on the disparity of care process and patient outcome. Methods We performed a retrospective review of an institutional trauma registry at an academic level 1 trauma center. Two intensive care unit teams staffed by either board-certified surgery or anesthesiology intensivists were assigned to manage critically ill trauma patients. Both teams provided care, collaborating with a trauma surgeon in house. We compared patient characteristics, care processes, and outcomes between surgery and anesthesiology groups using Wilcoxon tests or chi-square tests, as appropriate. Results We identified a total of 620 patients. Patient baseline characteristics including age, sex, transfer status, injury type, injury severity score, and Glasgow coma scale were similar between groups. We found no significant difference in care processes and outcomes between groups. In a logistic regression model, intensivists’ base specialty of training was not a significant factor for mortality (odds ratio, 1.46; 95% confidence interval; 0.79–2.80; P  = 0.22) and major complication (odds ratio, 1.11; 95% confidence interval, 0.73–1.67; P  = 0.63). Conclusions Intensive care unit teams collaborating with trauma surgeons had minimal disparity of care processes and similar patient outcomes regardless of intensivists’ base specialty of training.
doi_str_mv 10.1016/j.jss.2013.03.091
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The purpose of this study was to investigate the impact of intensivists’ base specialty of training on the disparity of care process and patient outcome. Methods We performed a retrospective review of an institutional trauma registry at an academic level 1 trauma center. Two intensive care unit teams staffed by either board-certified surgery or anesthesiology intensivists were assigned to manage critically ill trauma patients. Both teams provided care, collaborating with a trauma surgeon in house. We compared patient characteristics, care processes, and outcomes between surgery and anesthesiology groups using Wilcoxon tests or chi-square tests, as appropriate. Results We identified a total of 620 patients. Patient baseline characteristics including age, sex, transfer status, injury type, injury severity score, and Glasgow coma scale were similar between groups. We found no significant difference in care processes and outcomes between groups. In a logistic regression model, intensivists’ base specialty of training was not a significant factor for mortality (odds ratio, 1.46; 95% confidence interval; 0.79–2.80; P  = 0.22) and major complication (odds ratio, 1.11; 95% confidence interval, 0.73–1.67; P  = 0.63). Conclusions Intensive care unit teams collaborating with trauma surgeons had minimal disparity of care processes and similar patient outcomes regardless of intensivists’ base specialty of training.</description><identifier>ISSN: 0022-4804</identifier><identifier>EISSN: 1095-8673</identifier><identifier>DOI: 10.1016/j.jss.2013.03.091</identifier><identifier>PMID: 23611720</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject><![CDATA[Adult ; Aged ; Anesthesiology - education ; Anesthesiology - organization & administration ; Base specialty of training ; Care process ; Certification ; Critical Care - manpower ; Critical Care - organization & administration ; Critical Illness - epidemiology ; Critical Illness - therapy ; Critically ill trauma patient ; Female ; General Surgery - education ; General Surgery - organization & administration ; Humans ; Incidence ; Intensive Care Units - manpower ; Intensive Care Units - organization & administration ; Intensivist ; Logistic Models ; Male ; Medical Staff, Hospital - education ; Medical Staff, Hospital - organization & administration ; Medicine - organization & administration ; Middle Aged ; Outcome ; Outcome and Process Assessment (Health Care) ; Registries ; Retrospective Studies ; Surgery ; Trauma Centers - manpower ; Trauma Centers - organization & administration ; Wounds and Injuries - epidemiology ; Wounds and Injuries - therapy]]></subject><ispartof>The Journal of surgical research, 2013-09, Vol.184 (1), p.577-581</ispartof><rights>Elsevier Inc.</rights><rights>2013 Elsevier Inc.</rights><rights>Copyright © 2013 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-a9e65ad626809b616d16e2f0bc91a061496c8104989829db9448b74d56334b03</citedby><cites>FETCH-LOGICAL-c408t-a9e65ad626809b616d16e2f0bc91a061496c8104989829db9448b74d56334b03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S002248041300303X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23611720$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Matsushima, Kazuhide, MD</creatorcontrib><creatorcontrib>Goldwasser, Eleanor R., BA</creatorcontrib><creatorcontrib>Schaefer, Eric W., MS</creatorcontrib><creatorcontrib>Armen, Scott B., MD</creatorcontrib><creatorcontrib>Indeck, Matthew C., MD</creatorcontrib><title>The impact of intensivists' base specialty of training on care process and outcomes of critically ill trauma patients</title><title>The Journal of surgical research</title><addtitle>J Surg Res</addtitle><description>Abstract Background The care of the critically ill trauma patients is provided by intensivists with various base specialties of training. The purpose of this study was to investigate the impact of intensivists’ base specialty of training on the disparity of care process and patient outcome. Methods We performed a retrospective review of an institutional trauma registry at an academic level 1 trauma center. Two intensive care unit teams staffed by either board-certified surgery or anesthesiology intensivists were assigned to manage critically ill trauma patients. Both teams provided care, collaborating with a trauma surgeon in house. We compared patient characteristics, care processes, and outcomes between surgery and anesthesiology groups using Wilcoxon tests or chi-square tests, as appropriate. Results We identified a total of 620 patients. Patient baseline characteristics including age, sex, transfer status, injury type, injury severity score, and Glasgow coma scale were similar between groups. We found no significant difference in care processes and outcomes between groups. In a logistic regression model, intensivists’ base specialty of training was not a significant factor for mortality (odds ratio, 1.46; 95% confidence interval; 0.79–2.80; P  = 0.22) and major complication (odds ratio, 1.11; 95% confidence interval, 0.73–1.67; P  = 0.63). Conclusions Intensive care unit teams collaborating with trauma surgeons had minimal disparity of care processes and similar patient outcomes regardless of intensivists’ base specialty of training.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesiology - education</subject><subject>Anesthesiology - organization &amp; administration</subject><subject>Base specialty of training</subject><subject>Care process</subject><subject>Certification</subject><subject>Critical Care - manpower</subject><subject>Critical Care - organization &amp; administration</subject><subject>Critical Illness - epidemiology</subject><subject>Critical Illness - therapy</subject><subject>Critically ill trauma patient</subject><subject>Female</subject><subject>General Surgery - education</subject><subject>General Surgery - organization &amp; administration</subject><subject>Humans</subject><subject>Incidence</subject><subject>Intensive Care Units - manpower</subject><subject>Intensive Care Units - organization &amp; administration</subject><subject>Intensivist</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical Staff, Hospital - education</subject><subject>Medical Staff, Hospital - organization &amp; administration</subject><subject>Medicine - organization &amp; administration</subject><subject>Middle Aged</subject><subject>Outcome</subject><subject>Outcome and Process Assessment (Health Care)</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Trauma Centers - manpower</subject><subject>Trauma Centers - organization &amp; administration</subject><subject>Wounds and Injuries - epidemiology</subject><subject>Wounds and Injuries - therapy</subject><issn>0022-4804</issn><issn>1095-8673</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU2LFDEQhoMo7rj6A7xIbnrpsfIxmQ6CIIsfCwt72Dl4C-l0jabtL1Pphfn3ppnVg4eFgqLI-76knmLstYCtAGHed9uOaCtBqC2UsuIJ2wiwu6o2e_WUbQCkrHQN-oK9IOqgzHavnrMLqYwQewkbthx-Io_D7EPm05HHMeNI8T5Spre88YScZgzR9_m0vufk4xjHH3waefAJ-ZymgETcjy2flhymAWkVhhRzDL7vTzz2_epbBs9nnyOOmV6yZ0ffE7566Jfs8OXz4epbdXP79frq000VNNS58hbNzrdGmhpsY4RphUF5hCZY4cEIbU2oBWhb21ratrFa181etzujlG5AXbJ359jyy98LUnZDpIB970ecFnJCS2u0LElFKs7SkCaihEc3pzj4dHIC3Arbda7AditsB6Xs6nnzEL80A7b_HH_pFsGHswDLjvcRk6NQ9g_YxoQhu3aKj8Z__M8d-gK_QP2FJ6RuWtJY4DnhSDpwd-u112MLBaBAfVd_ACHWpMU</recordid><startdate>20130901</startdate><enddate>20130901</enddate><creator>Matsushima, Kazuhide, MD</creator><creator>Goldwasser, Eleanor R., BA</creator><creator>Schaefer, Eric W., MS</creator><creator>Armen, Scott B., MD</creator><creator>Indeck, Matthew C., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130901</creationdate><title>The impact of intensivists' base specialty of training on care process and outcomes of critically ill trauma patients</title><author>Matsushima, Kazuhide, MD ; Goldwasser, Eleanor R., BA ; Schaefer, Eric W., MS ; Armen, Scott B., MD ; Indeck, Matthew C., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-a9e65ad626809b616d16e2f0bc91a061496c8104989829db9448b74d56334b03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anesthesiology - education</topic><topic>Anesthesiology - organization &amp; administration</topic><topic>Base specialty of training</topic><topic>Care process</topic><topic>Certification</topic><topic>Critical Care - manpower</topic><topic>Critical Care - organization &amp; administration</topic><topic>Critical Illness - epidemiology</topic><topic>Critical Illness - therapy</topic><topic>Critically ill trauma patient</topic><topic>Female</topic><topic>General Surgery - education</topic><topic>General Surgery - organization &amp; administration</topic><topic>Humans</topic><topic>Incidence</topic><topic>Intensive Care Units - manpower</topic><topic>Intensive Care Units - organization &amp; administration</topic><topic>Intensivist</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical Staff, Hospital - education</topic><topic>Medical Staff, Hospital - organization &amp; administration</topic><topic>Medicine - organization &amp; administration</topic><topic>Middle Aged</topic><topic>Outcome</topic><topic>Outcome and Process Assessment (Health Care)</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Trauma Centers - manpower</topic><topic>Trauma Centers - organization &amp; administration</topic><topic>Wounds and Injuries - epidemiology</topic><topic>Wounds and Injuries - therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Matsushima, Kazuhide, MD</creatorcontrib><creatorcontrib>Goldwasser, Eleanor R., BA</creatorcontrib><creatorcontrib>Schaefer, Eric W., MS</creatorcontrib><creatorcontrib>Armen, Scott B., MD</creatorcontrib><creatorcontrib>Indeck, Matthew C., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of surgical research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Matsushima, Kazuhide, MD</au><au>Goldwasser, Eleanor R., BA</au><au>Schaefer, Eric W., MS</au><au>Armen, Scott B., MD</au><au>Indeck, Matthew C., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The impact of intensivists' base specialty of training on care process and outcomes of critically ill trauma patients</atitle><jtitle>The Journal of surgical research</jtitle><addtitle>J Surg Res</addtitle><date>2013-09-01</date><risdate>2013</risdate><volume>184</volume><issue>1</issue><spage>577</spage><epage>581</epage><pages>577-581</pages><issn>0022-4804</issn><eissn>1095-8673</eissn><abstract>Abstract Background The care of the critically ill trauma patients is provided by intensivists with various base specialties of training. The purpose of this study was to investigate the impact of intensivists’ base specialty of training on the disparity of care process and patient outcome. Methods We performed a retrospective review of an institutional trauma registry at an academic level 1 trauma center. Two intensive care unit teams staffed by either board-certified surgery or anesthesiology intensivists were assigned to manage critically ill trauma patients. Both teams provided care, collaborating with a trauma surgeon in house. We compared patient characteristics, care processes, and outcomes between surgery and anesthesiology groups using Wilcoxon tests or chi-square tests, as appropriate. Results We identified a total of 620 patients. Patient baseline characteristics including age, sex, transfer status, injury type, injury severity score, and Glasgow coma scale were similar between groups. We found no significant difference in care processes and outcomes between groups. In a logistic regression model, intensivists’ base specialty of training was not a significant factor for mortality (odds ratio, 1.46; 95% confidence interval; 0.79–2.80; P  = 0.22) and major complication (odds ratio, 1.11; 95% confidence interval, 0.73–1.67; P  = 0.63). Conclusions Intensive care unit teams collaborating with trauma surgeons had minimal disparity of care processes and similar patient outcomes regardless of intensivists’ base specialty of training.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23611720</pmid><doi>10.1016/j.jss.2013.03.091</doi><tpages>5</tpages></addata></record>
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subjects Adult
Aged
Anesthesiology - education
Anesthesiology - organization & administration
Base specialty of training
Care process
Certification
Critical Care - manpower
Critical Care - organization & administration
Critical Illness - epidemiology
Critical Illness - therapy
Critically ill trauma patient
Female
General Surgery - education
General Surgery - organization & administration
Humans
Incidence
Intensive Care Units - manpower
Intensive Care Units - organization & administration
Intensivist
Logistic Models
Male
Medical Staff, Hospital - education
Medical Staff, Hospital - organization & administration
Medicine - organization & administration
Middle Aged
Outcome
Outcome and Process Assessment (Health Care)
Registries
Retrospective Studies
Surgery
Trauma Centers - manpower
Trauma Centers - organization & administration
Wounds and Injuries - epidemiology
Wounds and Injuries - therapy
title The impact of intensivists' base specialty of training on care process and outcomes of critically ill trauma patients
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