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Original Articles: Adult Cardiac

Impact of 24-Hour In-House Intensivists on a Dedicated Cardiac Surgery Intensive Care Unit

^a Cardiovascular Health Research in Manitoba (CHaRM) Investigator Group, Cardiac Sciences Program, St. Boniface General Hospital/I.H. Asper Clinical Research Institute, Winnipeg, Manitoba, Canada
^b Department of Hematology/Medical Oncology, Cancercare Manitoba, Winnipeg, Manitoba, Canada
^c Sections of Hematology and Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada

Accepted for publication April 17, 2009.

^_* Address correspondence to Dr Arora, Cardiac Sciences Program, 369 Tache Ave, CR 3012, St Boniface General Hospital/I.H. Asper Clinical Research Institute, Winnipeg, Manitoba, R2H 2A7, Canada (Email: rakesh.arora{at}mac.com).

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: Intensive care unit (ICU) physician staffing models for cardiac surgery patients vary widely and correlate poorly with outcomes. Clinical outcomes associated with 24-hour, in-house intensivists working in a dedicated post–cardiac surgical unit has not been previously investigated. We sought to examine the safety and efficacy of such a model.

Methods: A retrospective, propensity-matched, cohort study of all patients undergoing a cardiac surgical procedure at a single tertiary center was performed. The control cohort (n = 1,467) consisted of patients admitted to the traditional, mixed surgical intensive care unit (SICU) from January 2005 to January 2007. The intervention cohort (n = 1,089) consisted of patients admitted to a newly created "hybrid" cardiac surgery ICU (CICU) from January 2007 to January 2008, which was staffed by 24-hour in-house consultant intensivists and a daytime, fast track cardiac anesthesiologist. The primary outcomes were blood product utilization, requirement for ventilation, and ICU recidivism.

Results: The proportion of patients in the CICU cohort who received transfused red blood cells was decreased compared with the SICU cohort (30.2% versus 42.3%, p < 0.001). Similar reductions in platelets and fresh frozen plasma were also observed. The CICU patients were less likely to arrive to the ICU intubated (43.7% versus 66.5%, p < 0.001). There were no differences in postoperative complications. Overall hospital length of stay was reduced in the CICU cohort by a median of 1 day (6 days [interquartile range, 5 to 8] versus 7 days [5 to 9], p < 0.001). Significant reductions in mortality and ICU recidivism were not observed.

Conclusions: The current Manitoba CICU model of 24-hour intensive care physician/cardiac anesthesiologist staffing in postoperative cardiac surgery care is associated with reduced transfusion of blood components, decreased requirement for mechanical ventilation, and shorter hospital length of stay.