Association of patient-to-intensivist ratio with hospital mortality in Australia and New Zealand,Intensive Care Medicine

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Association of patient-to-intensivist ratio with hospital mortality in Australia and New Zealand
Intensive Care Medicine ( IF 38.9 ) Pub Date : 2021-12-02 , DOI: 10.1007/s00134-021-06575-z
Hayley B Gershengorn _{1,

2} , David V Pilcher _{3,

4,

5} , Edward Litton _{6,

7} , Matthew Anstey _{8,

9} , Allan Garland _{10,

11,

12} , Hannah Wunsch _{13,

14}

Affiliation

Division of Pulmonary, Critical Care, and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA.
Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, VIC, Australia.
Department of Intensive Care, Alfred Hospital, Melbourne, VIC, Australia.
Intensive Care Unit, St John of God Hospital, Subiaco, WA, Australia.
School of Medicine, University of Western Australia, Perth, WA, Australia.
Intensive Care Department, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
School of Public Health, Curtin University, Bentley, WA, Australia.
Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.
Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, MB, Canada.
Department of Critical Care Medicine, Sunnybrook Hospital, Toronto, ON, Canada.
Department of Anesthesiology and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.

Purpose

The impact of intensivist workload on intensive care unit (ICU) outcomes is incompletely described and assessed across healthcare systems and countries. We sought to examine the association of patient-to-intensivist ratio (PIR) with hospital mortality in Australia/New Zealand (ANZ) ICUs.

Methods

We conducted a retrospective study of adult admissions to ANZ ICUs (August 2016–June 2018) using two cohorts: “narrow”, based on previously used criteria including restriction to ICUs with a single daytime intensivist; and “broad”, refined by individual ICU daytime staffing information. The exposure was average daily PIR and the outcome was hospital mortality. We used summary statistics to describe both cohorts and multilevel multivariable logistic regression models to assess the association of PIR with mortality. In each, PIR was modeled using restricted cubic splines to allow for non-linear associations. The broad cohort model included non-PIR physician and non-physician staffing covariables.

Results

The narrow cohort of 27,380 patients across 67 ICUs (predicted mortality: median 1.2% [IQR 0.4–1.4%]; mean 5.9% [sd 13.2%]) had a median PIR of 10.1 (IQR 7–14). The broad cohort of 91,206 patients across 73 ICUs (predicted mortality: 1.9% [0.6–6.5%]; 7.6% [14.9%]) had a median PIR of 7.8 (IQR 5.8–10.2). We found no association of PIR with mortality in either the narrow (PIR 1st spline term odds ratio [95% CI]: 1 [0.94, 1.06], Wald testing of spline terms p = 0.61) or the broad (1.02 [0.97, 1.07], p = 0.4) cohort.

Conclusion

We found no association of PIR with hospital mortality across ANZ ICUs. The low cohort predicted mortality may limit external validity.

中文翻译：

澳大利亚和新西兰患者与重症监护医师的比例与医院死亡率的关系

目的

重症监护工作量对重症监护病房 (ICU) 结局的影响在医疗保健系统和国家/地区的描述和评估不完整。我们试图检查澳大利亚/新西兰 (ANZ) ICU 中患者与重症监护医师的比率 (PIR) 与住院死亡率之间的关系。

方法

我们使用两个队列对 ANZ ICU 的成人入院（2016 年 8 月至 2018 年 6 月）进行了一项回顾性研究：和“广泛”，由个别 ICU 日间人员配备信息细化。暴露是平均每日 PIR，结果是住院死亡率。我们使用汇总统计数据来描述队列和多水平多变量逻辑回归模型，以评估 PIR 与死亡率的关联。在每一个中，PIR 都使用受限三次样条进行建模，以允许非线性关联。广泛的队列模型包括非 PIR 医师和非医师人员配备协变量。

结果

67 个 ICU 的 27,380 名患者组成的狭窄队列（预测死亡率：中位数 1.2% [IQR 0.4–1.4%]；平均 5.9% [sd 13.2%]）的中位 PIR 为 10.1（IQR 7–14）。来自 73 个 ICU 的 91,206 名患者的广泛队列（预测死亡率：1.9% [0.6-6.5%]；7.6% [14.9%]）的中位 PIR 为 7.8（IQR 5.8-10.2）。我们发现 PIR 与狭义（PIR 第一样条项优势比 [95% CI]：1 [0.94, 1.06]，样条项的 Wald 检验p = 0.61）或广义（1.02 [0.97, 1.07 ]，p = 0.4) 队列。