Two Weeks Versus One Week of Maximal Patient-Intensivist Continuity for Adult Medical Intensive Care Patients: A Two-Center Target Trial Emulation.

IF 7.7 1区医学 Q1 CRITICAL CARE MEDICINE Critical Care Medicine Pub Date : 2024-09-01 Epub Date: 2024-05-07 DOI:10.1097/CCM.0000000000006322

Andrew J Admon, Shirley Cohen-Mekelburg, Megan Opatrny, Kathleen T Lee, Anica C Law, Hayley B Gershengorn, Thomas S Valley, Hallie C Prescott, Michael J Wiktor, Jayashree Neeluru, Colin R Cooke, Gary E Weissman

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Abstract

Objectives: To compare outcomes for 2 weeks vs. 1 week of maximal patient-intensivist continuity in the ICU.

Design: Retrospective cohort study.

Setting: Two U.S. urban, teaching, medical ICUs where intensivists were scheduled for 2-week service blocks: site A was in the Midwest and site B was in the Northeast.

Patients: Patients 18 years old or older admitted to a study ICU between March 1, 2017, and February 28, 2020.

Interventions: None.

Measurements and main results: We applied target trial emulation to compare admission during an intensivist's first week (as a proxy for 2 wk of maximal continuity) vs. admission during their second week (as a proxy for 1 wk of maximal continuity). Outcomes included hospital mortality, ICU length of stay, and, for mechanically ventilated patients, duration of ventilation. Exploratory outcomes included imaging, echocardiogram, and consultation orders. We used inverse probability weighting to adjust for baseline differences and random-effects meta-analysis to calculate overall effect estimates. Among 2571 patients, 1254 were admitted during an intensivist's first week and 1317 were admitted during a second week. At sites A and B, hospital mortality rates were 25.8% and 24.2%, median ICU length of stay were 4 and 2 days, and median mechanical ventilation durations were 3 and 3 days, respectively. There were no differences in adjusted mortality (odds ratio [OR], 1.01 [95% CI, 0.96-1.06]) or ICU length of stay (-0.25 d [-0.82 d to +0.32 d]) for 2 weeks vs. 1 week of maximal continuity. Among mechanically ventilated patients, there were no differences in adjusted mortality (OR, 1.00 [0.87-1.16]), ICU length of stay (+0.06 d [-0.78 d to +0.91 d]), or duration of mechanical ventilation (+0.37 d [-0.46 d to +1.21 d]) for 2 weeks vs. 1 week of maximal continuity.

Conclusions: Two weeks of maximal patient-intensivist continuity was not associated with differences in clinical outcomes compared with 1 week in two medical ICUs.

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成人内科重症监护患者两周与一周的最大患者-重症监护医师连续性对比：双中心目标试验模拟。

目的比较重症监护室中患者与医护人员最大连续性 2 周与 1 周的结果：设计：回顾性队列研究：两所美国城市教学医疗重症监护病房，重症监护医师被安排在其中进行为期 2 周的服务：A 病区位于美国中西部，B 病区位于美国东北部：干预措施：无：测量和主要结果：我们采用目标试验仿真法，比较了重症监护医师第一周入院（作为2周最大连续性的代表）与第二周入院（作为1周最大连续性的代表）的情况。结果包括住院死亡率、重症监护室住院时间，以及机械通气患者的通气时间。探索性结果包括成像、超声心动图和会诊单。我们使用反概率加权法调整基线差异，并使用随机效应荟萃分析法计算总体效应估计值。在 2571 名患者中，有 1254 名患者在重症监护医师的第一周入院，1317 名患者在第二周入院。A、B两地的住院死亡率分别为25.8%和24.2%，重症监护室住院时间中位数分别为4天和2天，机械通气时间中位数分别为3天和3天。调整后的死亡率（几率比 [OR]，1.01 [95% CI，0.96-1.06]）或重症监护室住院时间（-0.25 天 [-0.82 天至 +0.32 天]）在最大持续时间为 2 周与 1 周之间没有差异。在机械通气患者中，2周与1周最大连续性相比，调整后死亡率（OR，1.00 [0.87-1.16]）、ICU住院时间（+0.06 d [-0.78 d to +0.91 d]）或机械通气持续时间（+0.37 d [-0.46 d to +1.21 d]）均无差异：结论：在两家内科重症监护病房中，患者与重症监护医师连续工作两周与连续工作一周在临床结果上没有差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Critical Care Medicine 医学-危重病医学

CiteScore

16.30

自引率

5.70%

发文量

728

审稿时长

2 months

期刊介绍： Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.