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Article
December 16, 1988

Impact of Critical Care Physician Staffing on Patients With Septic Shock in a University Hospital Medical Intensive Care Unit

Author Affiliations

From the Department of Internal Medicine, Division of Critical Care Medicine, Wayne State University School of Medicine and the Detroit Receiving Hospital—University Health Center, Detroit (Drs Haupt and Carlson and Ms Thill-Baharozian). Dr Reynolds is now with the Maryland Institute for Emergency Medical Services Systems, Baltimore.

From the Department of Internal Medicine, Division of Critical Care Medicine, Wayne State University School of Medicine and the Detroit Receiving Hospital—University Health Center, Detroit (Drs Haupt and Carlson and Ms Thill-Baharozian). Dr Reynolds is now with the Maryland Institute for Emergency Medical Services Systems, Baltimore.

JAMA. 1988;260(23):3446-3450. doi:10.1001/jama.1988.03410230064029
Abstract

To evaluate the effects of reorganizing physician resources in a medical intensive care unit (MICU), we studied the impact of these changes in patients with septic shock. Patients were compared during two consecutive 12-month periods: (1) an interval in which faculty without critical care medicine (CCM) training supervised the MICU (before CCM, n = 100) and (2) following staffing with physicians formally trained in CCM (after CCM, n = 112). Acute Physiology and Chronic Health Evaluation scores were utilized to compare severity of illness and were similar for each group (29 ±11 before CCM vs 28 ± 10 after CCM). However, mortality was significantly lower during the post-CCM interval (74% vs 57%, respectively). There was no significant difference in the frequency of use of mechanical ventilation (83% vs 87%), although pulmonary artery catheters (48% vs 64%) and arterial catheters (24% vs 73%) were employed more frequently after CCM. The number of subspecialty consultations and MICU and hospital length of stay were similar for both intervals. We conclude that the implementation of dedicated staffing by CCM physicians in a university hospital MICU was associated with a favorable impact on patients with septic shock.

(JAMA 1988;260:3446-3450)

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