Impact of Nighttime Cardiovascular Intensive Care Unit Staffing on Failure to Rescue and Revenue.

BACKGROUND

Failure to rescue (FTR) is mortality following postoperative complication. We investigated the impact of nighttime intensivist staffing and FTR after cardiac surgery.

METHODS

We included patients who underwent cardiac surgery to examine FTR, defined as mortality in those who experienced a Society of Thoracic Surgeons-defined major complication. Era 2 (7/2021-6/2023) and Era 1 (7/2016-6/2021) were characterized by presence and absence of nighttime intensivists staffing, respectively. Complications and FTR rates, daily ICU census, and relative value units (RVUs) were compared.

RESULTS

Among 5,654 patients, 17% (284/1,661) in Era 2 had at least one complication versus 19% (769/3,993) in Era 1 (P=0.057). Among patients with complications, FTR incidence was 8% (22/284) in Era 2 versus 19% (145/769) in Era 1 (P<0.001). Daily average ICU census did not change (12.3 in Era 2 vs. 12.0 in Era 1, P=0.386). Comparing mean annual RVUs during the two fiscal years in Era 2 (35,613/year) to what would have been expected based on the last two fiscal years of Era 1 (26,744/year), a significant increase of +8,870/year was observed (95% CI=3,876-13,863, P=0.028). Multivariable analyses found no difference in the risk of major complications comparing Era 2 versus Era 1 (OR=1.04, 95% CI=0.89-1.23, P=0.602), and a 59% reduction in FTR risk in Era 2 versus Era 1 (OR=0.41, 95% CI=0.25-0.67, P<0.001).

CONCLUSIONS

Nighttime ICU coverage reduced FTR rates in post-cardiotomy patients while complication rates and ICU census remained stable. Furthermore, the increase in RVUs suggested an economically sustainable model.

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.