The impact of PICU physician staffing on patient outcomes

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  • Fujiwara Naoki
    Division of Pediatric Critical Care, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center
  • Seino Yusuke
    Division of Pediatric Critical Care, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center
  • Yasaka Yuki
    Division of Pediatric Critical Care, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center
  • Seki Yumiko
    Division of Pediatric Critical Care, Okinawa Prefectural Nanbu Medical Center & Children's Medical Center

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  • 小児集中治療専従医配置が患者予後に与えたインパクト

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Objectives: To evaluate the impact of the presence of pediatric intensivists on clinical outcomes, including mortality, in our PICU. Methods: The presence of pediatric intensivists in our PICU was implemented into our practice in February 2010. To evaluate the impact on clinical outcomes before and after the implementation, we reviewed all the patients who were admitted to our PICU from April 1, 2008 to March 31, 2012. We calculated the expected mortality based on the pediatric index of mortality 2 (PIM2) scoring system and investigated the impact of the implementation on PICU mortality, duration of mechanical ventilation, and PICU length of stay using multivariable analysis. Results: A total of 1,111 patients were admitted to our PICU over the 4-year period; 520 in pre-implementation period and 591 in post-implementation period. The PIM2 score was significantly higher in the post-implementation arm (P<0.001). The presence of pediatric intensivists was associated with lower PICU mortality [OR 0.36 (95%CI 0.15-0.89), P=0.026], shorter length of PICU stay [relative risk (RR) 0.94 (95%CI 0.89-0.98), P=0.004], and shorter duration of invasive mechanical ventilation [RR 0.94 (95%CI 0.89-0.99), P=0.045]. Conclusion: The presence of pediatric intensivists improved patient outcomes in our PICU.

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