지원사업
학술연구/단체지원/교육 등 연구자 활동을 지속하도록 DBpia가 지원하고 있어요.
커뮤니티
연구자들이 자신의 연구와 전문성을 널리 알리고, 새로운 협력의 기회를 만들 수 있는 네트워킹 공간이에요.
논문 기본 정보
- 자료유형
- 학술저널
- 저자정보
- 저널정보
- 대한외과학회 Annals of Surgical Treatment and Research Annals of Surgical Treatment and Research Vol.86 No.6
- 발행연도
- 2014.6
- 수록면
- 319 - 324 (6page)
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초록· 키워드
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Purpose: An intensivist is a key factor in the mortality of patients admitted to the intensive care unit (ICU). The aim of this study was to evaluate the effect of an intensivist on clinical outcomes of patients admitted to a surgical ICU.
Methods: During the study period, the surgical ICU was converted from an open ICU to an intensivist-directed ICU managed by an intensivist who was board certified in both general surgery and critical care medicine. We compared consecutive patients admitted to the surgical ICU before and after implementing the intensivist-directed care. The primary outcome was ICU mortality, and secondary outcomes were hospital mortality, 90-day mortality, length of hospital stay, ICU-free days, ventilator-free days, and ICU readmission rate.
Results: A total of 441 patients were included in this study: 188 before implementation of the intensivist and 253 after implementation. Clinical characteristics were not different between the two groups. ICU mortality decreased from 11.7% to 6.3% (P = 0.047) after implementation, and 90-day mortality also decreased significantly (P = 0.008). The adjusted hazard ratio of the intensivist for ICU mortality was 0.43 (95% confidence interval, 0.22?0.87; P = 0.020). ICU-free days (P = 0.013) and the hospital length of stay (P = 0.032) were significantly improved after implementing the intensivist-directed care. Before implementation period, 16.0% of patients were readmitted, compared with only 9.9% after implementation (P = 0.05).
Conclusion: Implementing intensivist-directed care in the surgical ICU was associated with significant improvements in ICU mortality and significant clinical outcomes.
Methods: During the study period, the surgical ICU was converted from an open ICU to an intensivist-directed ICU managed by an intensivist who was board certified in both general surgery and critical care medicine. We compared consecutive patients admitted to the surgical ICU before and after implementing the intensivist-directed care. The primary outcome was ICU mortality, and secondary outcomes were hospital mortality, 90-day mortality, length of hospital stay, ICU-free days, ventilator-free days, and ICU readmission rate.
Results: A total of 441 patients were included in this study: 188 before implementation of the intensivist and 253 after implementation. Clinical characteristics were not different between the two groups. ICU mortality decreased from 11.7% to 6.3% (P = 0.047) after implementation, and 90-day mortality also decreased significantly (P = 0.008). The adjusted hazard ratio of the intensivist for ICU mortality was 0.43 (95% confidence interval, 0.22?0.87; P = 0.020). ICU-free days (P = 0.013) and the hospital length of stay (P = 0.032) were significantly improved after implementing the intensivist-directed care. Before implementation period, 16.0% of patients were readmitted, compared with only 9.9% after implementation (P = 0.05).
Conclusion: Implementing intensivist-directed care in the surgical ICU was associated with significant improvements in ICU mortality and significant clinical outcomes.
목차
INTRODUCTION
METHODS
RESULTS
DISCUSSION
REFERENCES
참고문헌 (21)
참고문헌 신청
1. [학술지(정기간행물)] - Pronovost P. / 2007 / Impact of the Leapfrog Group's intensive care unit physician staffing standard / J Crit Care 22 : 89 ~ 96
2. [학술지(정기간행물)] - Pronovost PJ. / 2002 / Physician staffing patterns and clinical outcomes in critically ill patients : a systematic review / JAMA 288 : 2151 ~ 2162
3. [학술지(정기간행물)] - Carson SS. / 1996 / Effects of organizational change in the medical intensive care unit of a teaching hospital : a comparison of 'open' and 'closed' formats / JAMA 276 : 322 ~ 328
4. [학술지(정기간행물)] - Ghorra S. / 1999 / Analysis of the effect of conversion from open to closed surgical intensive care unit / Ann Surg 229 : 163 ~ 171
5. [학술지(정기간행물)] - Nathens AB. / 2006 / The impact of an intensivist-model ICU on trauma-related mortality / Ann Surg 244 : 545 ~ 554
2. [학술지(정기간행물)] - Pronovost PJ. / 2002 / Physician staffing patterns and clinical outcomes in critically ill patients : a systematic review / JAMA 288 : 2151 ~ 2162
3. [학술지(정기간행물)] - Carson SS. / 1996 / Effects of organizational change in the medical intensive care unit of a teaching hospital : a comparison of 'open' and 'closed' formats / JAMA 276 : 322 ~ 328
4. [학술지(정기간행물)] - Ghorra S. / 1999 / Analysis of the effect of conversion from open to closed surgical intensive care unit / Ann Surg 229 : 163 ~ 171
5. [학술지(정기간행물)] - Nathens AB. / 2006 / The impact of an intensivist-model ICU on trauma-related mortality / Ann Surg 244 : 545 ~ 554
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