ICU staffing and patient outcomes: more work remains

• Type of Material: Article
• Authors: David Murphy, Emory University; Eddy Fan, ohns Hopkins Medical Institutions; David M. Needham, ohns Hopkins Medical Institutions
• Language: English
• Date: 2009-01-01
• Publisher: Lippincott, Williams & Wilkins: No Hybrid Open Access
• Publication Version: Final Published Version
• Copyright Statement: © 2009 BioMed Central Ltd
• License: Creative Commons Attribution 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1186/cc7113
• Title of Journal or Parent Work: Critical Care Nursing Quarterly
• ISSN: 0887-9303
• Volume: 13
• Issue: 1
• Start Page: 101
• End Page: 101
• Grant/Funding Information: DJM is supported by an institutional training grant from the National Institutes of Health (T32 HL007534). EF is supported by a Fellowship Award from the Canadian Institutes of Health Research.; DMN is supported by a Clinician-Scientist Award from the Canadian Institutes of Health Research.
• Keywords: DURATION; Life Sciences & Biomedicine; General & Internal Medicine; MODEL; STATES; INTENSIVE-CARE-UNIT; MORTALITY; Science & Technology; ACUTE LUNG INJURY; Critical Care Medicine; TIDAL VOLUME VENTILATION
• Research Categories: Health Sciences, Rehabilitation and Therapy; Health Sciences, General

Abstract

Many studies have demonstrated that closed intensive care units (ICUs), staffed by trained intensivists, are associated with improved patient outcomes. However, the mechanisms by which ICU organizational factors, such as physician staffing, influence patient outcomes are unclear. One potential mechanism is the increased utilization of evidence-based practices in closed ICUs. Cooke and colleagues investigated this hypothesis in a cohort of 759 acute lung injury patients in 23 ICUs in King County, Washington, USA. Although closed ICUs were independently associated with a modestly lower mean tidal volume, this finding did not explain the mortality benefit associated with a closed ICU model in this patient cohort. Future studies should evaluate other potential mechanisms by which closed ICUs improve patient outcomes. An improved understanding of these mechanisms may yield new targets for improving the quality of medical care for all ICU patients.