호흡기 내과계 중환자실 전공의 수와 중환자실 사망률의 관련성 = Pulmonology The number of resident physicians and the mortality rate in a medicalintensive care unit

다국어 초록 (Multilingual Abstract)

Background/Aims: The treatment outcome of patients hospitalized in intensive care units (ICUs) can be influenced by physician factors, including both intensivists and resident physicians. We evaluated the association between the number of residents who are exclusively responsible for the ICU and the mortality rate in a medical ICU. Methods: The data obtained from an open medical ICU in a teaching hospital from Jan. 2005 to Dec. 2009 were analyzed retrospectively. We evaluated the associations between the ICU mortality rate and both the number of resident physicians and the number of patient-days per resident physician using multivariate Poisson regression analysis adjusted for year and month. Results: The months with fewer than two residents tended to have a higher ICU mortality rate, although this difference was not significant in the univariate analyses. Multivariate Poisson regression analysis showed that months with fewer than two residents had a significantly higher ICU mortality rate compared with months with two residents (incidence risk ratio (IRR) 1.59, 95% confidence interval (CI) 1.05-2.41; p=0.029). The number of ICU patient-days per resident physician was not associated with the ICU mortality rate (IRR; 1.00, 95% CI, 0.99-1.01; p=0.649). Conclusions: The presence of fewer than two residents exclusively responsible for the medical ICU was an independent risk factor of a higher ICU mortality rate. However, no association was found between the number of ICU patient-days per resident physician and the ICU mortality rate. (Korean J Med 79:155-162, 2010)

참고문헌 (Reference)

1 "중환자의학회백서 제 1호 2009 국내 중환자실현황조사보고서" 중환자의학회 27-, 2010

2 신태림, "내과계 중환자실 패혈증 환자의 예후 예측인자 비교분석" 55 : 11-20, 1998

3 Rich EC, "The relationship of house staff experience to the cost and quality of inpatient care" 263 : 953-957, 1990

4 Ensminger SA, "The hospital mortality of patients admitted to the ICU on weekends" 126 : 1292-1298, 2004

5 Jacques CH, "The effects of sleep loss on cognitive performance of resident physicians" 30 : 223-229, 1990

6 Hawari FI, "The effect of implementing high-intensity intensive care unit staffing model on outcome of critically ill oncology patients" 37 : 1967-1971, 2009

7 Weinger MB, "Sleep deprivation and clinical performance" 287 : 955-957, 2002

8 Pronovost PJ, "Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review" 288 : 2151-2162, 2002

9 Pronovost PJ, "Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery" 281 : 1310-1317, 1999

10 Lee MT, "Mortality rates under the care of junior and senior surgery residents in a surgical intensive care unit/neurologic intensive care unit: a 5-year retrospective cohort study at Taoyuan Armed Forces General Hospital" 23 : 550-555, 2008

11 Finkielman JD, "Mortality rate and length of stay of patients admitted to the intensive care unit in July" 32 : 1161-1165, 2004

12 Camire E, "Medication errors in critical care: risk factors, prevention and disclosure" 180 : 936-943, 2009

13 Barry WA, "Is there a July phenomenon?: the effect of July admission on intensive care mortality and length of stay in teaching hospitals" 18 : 639-645, 2003

14 Billington EO, "Intensivists' base specialty of training is associated with variations in mortality and practice patterns" 13 : R209-, 2009

15 Dara SI, "Intensivist-to-bed ratio: association with outcomes in the medical ICU" 128 : 567-572, 2005

16 Pronovost PJ, "Intensive care unit nurse staffing and the risk for complications after abdominal aortic surgery" 4 : 199-206, 2001

17 Thorens JB, "Influence of the quality of nursing on the duration of weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease" 23 : 1807-1815, 1995

18 Buchwald D, "Indirect costs for medical education: is there a July phenomenon?" 149 : 765-768, 1989

19 Reynolds HN, "Impact of critical care physician staffingon patients with septic shock in a university hospital medical intensive care unit" 260 : 3446-3450, 1988

20 Giraud T, "Iatrogenic complications in adult intensive care units: a prospective two-center study" 21 : 40-51, 1993

21 Amaravadi RK, "ICU nurse-to-patient ratio is associated with complications and resource use after esophagectomy" 26 : 1857-1862, 2000

22 Aiken LH, "Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction" 288 : 1987-1993, 2002

23 Morales IJ, "Hospital mortality rate and length of stay in patients admitted at night to the intensive care unit" 31 : 858-863, 2003

24 Tarnow-Mordi WO, "Hospital mortality in relation to staff workload: a 4-year study in an adult intensive- care unit" 356 : 185-189, 2000

25 Carson SS, "Effects of organizational change in the medical intensive care unit of a teaching hospital: a comparison of 'open' and 'closed' formats" 276 : 322-328, 1996

26 Manthous CA, "Effects of a medical intensivist on patient care in a community teaching hospital" 72 : 391-399, 1997

27 Brilli RJ, "Critical care delivery in the intensive care unit: defining clinical roles and the best practice model" 29 : 2007-2019, 2001

28 Hillson SD, "Call nights and patients care: effects on inpatients at one teaching hospital" 7 : 405-410, 1992

29 Levy MM, "Association between critical care physician management and patient mortality in the intensive care unit" 148 : 801-809, 2008

30 Knaus WA, "APACHE II: a severity of disease classification system" 13 : 818-829, 1985

31 Cole L, "A prospective, multicenter study of the epidemiology, management, and outcome of se vere acute renal failure in a "closed" ICU system" 162 : 191-196, 2000

32 Le Gall JR, "A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study" 270 : 2957-2963, 1993