Effect of 24-hour mandatory versus on-demand critical care specialist presence on quality of care and family and provider satisfaction in the intensive care unit of a teaching hospital
OBJECTIVE:The benefit of continuous on-site presence by a staff academic critical care specialist in the intensive care unit of a teaching hospital is not known. We compared the quality of care and patient/family and provider satisfaction before and after changing the staffing model from on-demand t...
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| Veröffentlicht in: | Critical care medicine 2008-01, Vol.36 (1), p.36-44 |
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| creator | Gajic, Ognjen Afessa, Bekele Hanson, Andrew C Krpata, Tami Yilmaz, Murat Mohamed, Shehab F Rabatin, Jeffrey T Evenson, Laura K Aksamit, Timothy R Peters, Steve G Hubmayr, Rolf D Wylam, Mark E |
| description | OBJECTIVE:The benefit of continuous on-site presence by a staff academic critical care specialist in the intensive care unit of a teaching hospital is not known. We compared the quality of care and patient/family and provider satisfaction before and after changing the staffing model from on-demand to continuous 24-hr critical care specialist presence in the intensive care unit.
DESIGN:Two-year prospective cohort study of patient outcomes, processes of care, and family and provider survey of satisfaction, organization, and culture in the intensive care unit.
SETTING:Intensive care unit of a teaching hospital.
PATIENTS:Consecutive critically ill patients, their families, and their caregivers.
INTERVENTIONS:Introduction of night-shift coverage to provide continuous 24-hr on-site, as opposed to on-demand, critical care specialist presence.
MEASUREMENTS AND MAIN RESULTS:Of 2,622 patients included in the study, 1,301 were admitted before and 1,321 after the staffing model change. Baseline characteristics and adjusted intensive care unit and hospital mortality were similar between the two groups. The nonadherence to evidence-based care processes improved from 24% to 16% per patient-day after the staffing change (p = .002). The rate of intensive care unit complications decreased from 11% to 7% per patient-day (p = .023). When adjusted for predicted hospital length of stay, admission source, and do-not-resuscitate status, hospital length of stay significantly decreased during the second period (adjusted mean difference −1.4, 95% confidence interval −0.3 to −2.5 days, p = .017). The new model was considered optimal for patient care by the majority of the providers (78% vs. 38% before the intervention, p < .001). Family satisfaction was excellent during both study periods (mean score 5.87 ± 1.7 vs. 5.95 ± 2.0, p = .777).
CONCLUSIONS:The introduction of continuous (24-hr) on-site presence by a staff academic critical care specialist was associated with improved processes of care and staff satisfaction and decreased intensive care unit complication rate and hospital length of stay. |
| doi_str_mv | 10.1097/01.CCM.0000297887.84347.85 |
| format | Article |
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DESIGN:Two-year prospective cohort study of patient outcomes, processes of care, and family and provider survey of satisfaction, organization, and culture in the intensive care unit.
SETTING:Intensive care unit of a teaching hospital.
PATIENTS:Consecutive critically ill patients, their families, and their caregivers.
INTERVENTIONS:Introduction of night-shift coverage to provide continuous 24-hr on-site, as opposed to on-demand, critical care specialist presence.
MEASUREMENTS AND MAIN RESULTS:Of 2,622 patients included in the study, 1,301 were admitted before and 1,321 after the staffing model change. Baseline characteristics and adjusted intensive care unit and hospital mortality were similar between the two groups. The nonadherence to evidence-based care processes improved from 24% to 16% per patient-day after the staffing change (p = .002). The rate of intensive care unit complications decreased from 11% to 7% per patient-day (p = .023). When adjusted for predicted hospital length of stay, admission source, and do-not-resuscitate status, hospital length of stay significantly decreased during the second period (adjusted mean difference −1.4, 95% confidence interval −0.3 to −2.5 days, p = .017). The new model was considered optimal for patient care by the majority of the providers (78% vs. 38% before the intervention, p < .001). Family satisfaction was excellent during both study periods (mean score 5.87 ± 1.7 vs. 5.95 ± 2.0, p = .777).
CONCLUSIONS:The introduction of continuous (24-hr) on-site presence by a staff academic critical care specialist was associated with improved processes of care and staff satisfaction and decreased intensive care unit complication rate and hospital length of stay.</description><identifier>ISSN: 0090-3493</identifier><identifier>EISSN: 1530-0293</identifier><identifier>DOI: 10.1097/01.CCM.0000297887.84347.85</identifier><identifier>PMID: 18007270</identifier><identifier>CODEN: CCMDC7</identifier><language>eng</language><publisher>Hagerstown, MD: by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</publisher><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Attitude of Health Personnel ; Biological and medical sciences ; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis ; Clinical death. Palliative care. Organ gift and preservation ; Cohort Studies ; Consumer Behavior - statistics & numerical data ; Critical Care - manpower ; Health Care Surveys ; Hospitals, Teaching - manpower ; Humans ; Intensive care medicine ; Intensive Care Units - manpower ; Job Satisfaction ; Longitudinal Studies ; Medical sciences ; Minnesota ; Night Care - manpower ; Organizational Culture ; Outcome and Process Assessment (Health Care) ; Personnel Staffing and Scheduling ; Prospective Studies ; Quality of Health Care - statistics & numerical data ; Transfusions. Complications. Transfusion reactions. Cell and gene therapy</subject><ispartof>Critical care medicine, 2008-01, Vol.36 (1), p.36-44</ispartof><rights>2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</rights><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4586-af08ebc9f4c69c60e185450775ccdd2272000e849f759a1664727c1a58987633</citedby><cites>FETCH-LOGICAL-c4586-af08ebc9f4c69c60e185450775ccdd2272000e849f759a1664727c1a58987633</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,4010,27900,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19946478$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18007270$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gajic, Ognjen</creatorcontrib><creatorcontrib>Afessa, Bekele</creatorcontrib><creatorcontrib>Hanson, Andrew C</creatorcontrib><creatorcontrib>Krpata, Tami</creatorcontrib><creatorcontrib>Yilmaz, Murat</creatorcontrib><creatorcontrib>Mohamed, Shehab F</creatorcontrib><creatorcontrib>Rabatin, Jeffrey T</creatorcontrib><creatorcontrib>Evenson, Laura K</creatorcontrib><creatorcontrib>Aksamit, Timothy R</creatorcontrib><creatorcontrib>Peters, Steve G</creatorcontrib><creatorcontrib>Hubmayr, Rolf D</creatorcontrib><creatorcontrib>Wylam, Mark E</creatorcontrib><title>Effect of 24-hour mandatory versus on-demand critical care specialist presence on quality of care and family and provider satisfaction in the intensive care unit of a teaching hospital</title><title>Critical care medicine</title><addtitle>Crit Care Med</addtitle><description>OBJECTIVE:The benefit of continuous on-site presence by a staff academic critical care specialist in the intensive care unit of a teaching hospital is not known. We compared the quality of care and patient/family and provider satisfaction before and after changing the staffing model from on-demand to continuous 24-hr critical care specialist presence in the intensive care unit.
DESIGN:Two-year prospective cohort study of patient outcomes, processes of care, and family and provider survey of satisfaction, organization, and culture in the intensive care unit.
SETTING:Intensive care unit of a teaching hospital.
PATIENTS:Consecutive critically ill patients, their families, and their caregivers.
INTERVENTIONS:Introduction of night-shift coverage to provide continuous 24-hr on-site, as opposed to on-demand, critical care specialist presence.
MEASUREMENTS AND MAIN RESULTS:Of 2,622 patients included in the study, 1,301 were admitted before and 1,321 after the staffing model change. Baseline characteristics and adjusted intensive care unit and hospital mortality were similar between the two groups. The nonadherence to evidence-based care processes improved from 24% to 16% per patient-day after the staffing change (p = .002). The rate of intensive care unit complications decreased from 11% to 7% per patient-day (p = .023). When adjusted for predicted hospital length of stay, admission source, and do-not-resuscitate status, hospital length of stay significantly decreased during the second period (adjusted mean difference −1.4, 95% confidence interval −0.3 to −2.5 days, p = .017). The new model was considered optimal for patient care by the majority of the providers (78% vs. 38% before the intervention, p < .001). Family satisfaction was excellent during both study periods (mean score 5.87 ± 1.7 vs. 5.95 ± 2.0, p = .777).
CONCLUSIONS:The introduction of continuous (24-hr) on-site presence by a staff academic critical care specialist was associated with improved processes of care and staff satisfaction and decreased intensive care unit complication rate and hospital length of stay.</description><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Attitude of Health Personnel</subject><subject>Biological and medical sciences</subject><subject>Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis</subject><subject>Clinical death. Palliative care. Organ gift and preservation</subject><subject>Cohort Studies</subject><subject>Consumer Behavior - statistics & numerical data</subject><subject>Critical Care - manpower</subject><subject>Health Care Surveys</subject><subject>Hospitals, Teaching - manpower</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units - manpower</subject><subject>Job Satisfaction</subject><subject>Longitudinal Studies</subject><subject>Medical sciences</subject><subject>Minnesota</subject><subject>Night Care - manpower</subject><subject>Organizational Culture</subject><subject>Outcome and Process Assessment (Health Care)</subject><subject>Personnel Staffing and Scheduling</subject><subject>Prospective Studies</subject><subject>Quality of Health Care - statistics & numerical data</subject><subject>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</subject><issn>0090-3493</issn><issn>1530-0293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkc9u1DAQxiMEokvhFZCFBLcsdmzHNje0KrRSEZfeLdcZE4OTbG1nq32zPh5OdqX1wX9Gv29mPF9VfSJ4S7ASXzHZ7na_trisRgkpxVYyysrOX1UbwimuS5y-rjYYK1xTpuhV9S6lvxgTxgV9W10RibFoBN5ULzfOgc1ocqhhdT_NEQ1m7Eye4hEdIKY5oWmsO1iiyEafvTUBWRMBpT1Yb4JPGe0jJBgtFBY9zSWWj0vKFVuEzgw-HNfrPk4H30FEyWSfnLHZF5EfUe6hHBnG5A9wks6jX1szKIOxvR__oH5Ke59NeF-9cSYk-HA-r6uHHzcPu9v6_vfPu933-9oyLtvaOCzh0SrHbKtsi4FIzjgWglvbdU0jmjJFkEw5wZUhbcvKXCwxXCopWkqvqy-ntKXtpxlS1oNPFkIwI0xz0gITwRvGCvjtBNo4pRTB6X30g4lHTbBebNOY6GKbvtimV9u05EX88Vxlfhygu0jPPhXg8xkwqczfRTNany6cUqx0LgvHTtzzFHJx71-YnyHqHkzI_VqaNqyty6clJuVVL6GW_gd7DrLl</recordid><startdate>200801</startdate><enddate>200801</enddate><creator>Gajic, Ognjen</creator><creator>Afessa, Bekele</creator><creator>Hanson, Andrew C</creator><creator>Krpata, Tami</creator><creator>Yilmaz, Murat</creator><creator>Mohamed, Shehab F</creator><creator>Rabatin, Jeffrey T</creator><creator>Evenson, Laura K</creator><creator>Aksamit, Timothy R</creator><creator>Peters, Steve G</creator><creator>Hubmayr, Rolf D</creator><creator>Wylam, Mark E</creator><general>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</general><general>Lippincott</general><scope>IQODW</scope><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>200801</creationdate><title>Effect of 24-hour mandatory versus on-demand critical care specialist presence on quality of care and family and provider satisfaction in the intensive care unit of a teaching hospital</title><author>Gajic, Ognjen ; Afessa, Bekele ; Hanson, Andrew C ; Krpata, Tami ; Yilmaz, Murat ; Mohamed, Shehab F ; Rabatin, Jeffrey T ; Evenson, Laura K ; Aksamit, Timothy R ; Peters, Steve G ; Hubmayr, Rolf D ; Wylam, Mark E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4586-af08ebc9f4c69c60e185450775ccdd2272000e849f759a1664727c1a58987633</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Attitude of Health Personnel</topic><topic>Biological and medical sciences</topic><topic>Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis</topic><topic>Clinical death. Palliative care. Organ gift and preservation</topic><topic>Cohort Studies</topic><topic>Consumer Behavior - statistics & numerical data</topic><topic>Critical Care - manpower</topic><topic>Health Care Surveys</topic><topic>Hospitals, Teaching - manpower</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units - manpower</topic><topic>Job Satisfaction</topic><topic>Longitudinal Studies</topic><topic>Medical sciences</topic><topic>Minnesota</topic><topic>Night Care - manpower</topic><topic>Organizational Culture</topic><topic>Outcome and Process Assessment (Health Care)</topic><topic>Personnel Staffing and Scheduling</topic><topic>Prospective Studies</topic><topic>Quality of Health Care - statistics & numerical data</topic><topic>Transfusions. Complications. Transfusion reactions. Cell and gene therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gajic, Ognjen</creatorcontrib><creatorcontrib>Afessa, Bekele</creatorcontrib><creatorcontrib>Hanson, Andrew C</creatorcontrib><creatorcontrib>Krpata, Tami</creatorcontrib><creatorcontrib>Yilmaz, Murat</creatorcontrib><creatorcontrib>Mohamed, Shehab F</creatorcontrib><creatorcontrib>Rabatin, Jeffrey T</creatorcontrib><creatorcontrib>Evenson, Laura K</creatorcontrib><creatorcontrib>Aksamit, Timothy R</creatorcontrib><creatorcontrib>Peters, Steve G</creatorcontrib><creatorcontrib>Hubmayr, Rolf D</creatorcontrib><creatorcontrib>Wylam, Mark E</creatorcontrib><collection>Pascal-Francis</collection><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>Critical care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gajic, Ognjen</au><au>Afessa, Bekele</au><au>Hanson, Andrew C</au><au>Krpata, Tami</au><au>Yilmaz, Murat</au><au>Mohamed, Shehab F</au><au>Rabatin, Jeffrey T</au><au>Evenson, Laura K</au><au>Aksamit, Timothy R</au><au>Peters, Steve G</au><au>Hubmayr, Rolf D</au><au>Wylam, Mark E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of 24-hour mandatory versus on-demand critical care specialist presence on quality of care and family and provider satisfaction in the intensive care unit of a teaching hospital</atitle><jtitle>Critical care medicine</jtitle><addtitle>Crit Care Med</addtitle><date>2008-01</date><risdate>2008</risdate><volume>36</volume><issue>1</issue><spage>36</spage><epage>44</epage><pages>36-44</pages><issn>0090-3493</issn><eissn>1530-0293</eissn><coden>CCMDC7</coden><abstract>OBJECTIVE:The benefit of continuous on-site presence by a staff academic critical care specialist in the intensive care unit of a teaching hospital is not known. We compared the quality of care and patient/family and provider satisfaction before and after changing the staffing model from on-demand to continuous 24-hr critical care specialist presence in the intensive care unit.
DESIGN:Two-year prospective cohort study of patient outcomes, processes of care, and family and provider survey of satisfaction, organization, and culture in the intensive care unit.
SETTING:Intensive care unit of a teaching hospital.
PATIENTS:Consecutive critically ill patients, their families, and their caregivers.
INTERVENTIONS:Introduction of night-shift coverage to provide continuous 24-hr on-site, as opposed to on-demand, critical care specialist presence.
MEASUREMENTS AND MAIN RESULTS:Of 2,622 patients included in the study, 1,301 were admitted before and 1,321 after the staffing model change. Baseline characteristics and adjusted intensive care unit and hospital mortality were similar between the two groups. The nonadherence to evidence-based care processes improved from 24% to 16% per patient-day after the staffing change (p = .002). The rate of intensive care unit complications decreased from 11% to 7% per patient-day (p = .023). When adjusted for predicted hospital length of stay, admission source, and do-not-resuscitate status, hospital length of stay significantly decreased during the second period (adjusted mean difference −1.4, 95% confidence interval −0.3 to −2.5 days, p = .017). The new model was considered optimal for patient care by the majority of the providers (78% vs. 38% before the intervention, p < .001). Family satisfaction was excellent during both study periods (mean score 5.87 ± 1.7 vs. 5.95 ± 2.0, p = .777).
CONCLUSIONS:The introduction of continuous (24-hr) on-site presence by a staff academic critical care specialist was associated with improved processes of care and staff satisfaction and decreased intensive care unit complication rate and hospital length of stay.</abstract><cop>Hagerstown, MD</cop><pub>by the Society of Critical Care Medicine and Lippincott Williams & Wilkins</pub><pmid>18007270</pmid><doi>10.1097/01.CCM.0000297887.84347.85</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | Critical care medicine, 2008-01, Vol.36 (1), p.36-44 |
| issn | 0090-3493 1530-0293 |
| language | eng |
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| source | MEDLINE; Journals@Ovid Complete |
| subjects | Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Attitude of Health Personnel Biological and medical sciences Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis Clinical death. Palliative care. Organ gift and preservation Cohort Studies Consumer Behavior - statistics & numerical data Critical Care - manpower Health Care Surveys Hospitals, Teaching - manpower Humans Intensive care medicine Intensive Care Units - manpower Job Satisfaction Longitudinal Studies Medical sciences Minnesota Night Care - manpower Organizational Culture Outcome and Process Assessment (Health Care) Personnel Staffing and Scheduling Prospective Studies Quality of Health Care - statistics & numerical data Transfusions. Complications. Transfusion reactions. Cell and gene therapy |
| title | Effect of 24-hour mandatory versus on-demand critical care specialist presence on quality of care and family and provider satisfaction in the intensive care unit of a teaching hospital |
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