Research
Intensivists' base specialty of training is associated with variations in mortality and practice patterns
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* Corresponding author: Adam D Peets apeets@providencehealth.bc.ca
1 Department of Medicine, Foothills Medical Centre - North Tower, 9th floor, 1403 - 29thSt NW, Calgary AB, T2N 2T9, Canada
2 Department of Critical Care Medicine, Rm EG 23, 1403 - 29thST NW, Calgary AB, T2N 2T9, Canada
3 Division of Critical Care Medicine, Rm 239 Comox Building, St Paul's Hospital, 1081 Burrard St, Vancouver BC, V6Z 1Y6, Canada
Critical Care 2009, 13:R209 doi:10.1186/cc8227
See related commentary by Garland, http://ccforum.com/content/14/1/108 and related letter by Braun and Spies, http://ccforum.com/content/14/2/409
Published: 29 December 2009Abstract
Introduction
Current evidence regarding whether the staffing of intensive care units (ICUs) with a trained Intensivist benefits patient outcomes is discordant. We sought to determine whether, among certified Intensivists, base specialty of training could contribute to variation in practice patterns and patient outcomes in ICUs.
Methods
The records of all patients who were admitted to one of three closed multi-system ICUs within tertiary care centers in the Calgary Health Region, Alberta, Canada, during a five year period were retrospectively reviewed. Outcomes for patients admitted by Intensivists with base training in General Internal Medicine, Pulmonary Medicine, or other eligible base specialties (Anesthesia, General Surgery, and Emergency Medicine combined) were compared.
Results
ICU mortality in the entire cohort (n = 9,808) was 17.2% and in-hospital mortality was 32.0%. After controlling for potential confounders, ICU mortality (odds ratio (OR): 0.69; 95% confidence interval (CI): 0.52 to 0.94) was significantly lower for patients admitted by Intensivists with Pulmonary Medicine as a base specialty of training, but not ICU length of stay (LOS) (coefficient: 0.11; -0.20 to 0.42) or hospital mortality (OR: 0.88; 0.68 to 1.13). There was no difference in ICU or hospital mortality or length of stay between the three base specialty groups for patients who were admitted and managed by a single Intensivist for their entire ICU admission (n = 4,612). However, we identified significant variation in practice patterns between the three specialty groups for the number of invasive procedures performed and decisions to limit life-sustaining therapies.
Conclusions
Intensivists' base specialty of training is associated with practice pattern variations. This may contribute to differences in processes and outcomes of patient care.