Survey of Contemporary Cardiac Surgery Intensive Care Unit Models in the United States.

Autor:	Arora RC; Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada. Electronic address: rakeshcarora@gmail.com., Chatterjee S; Department of Surgery, Baylor College of Medicine, Houston, Texas., Shake JG; Department of Surgery, University of Mississippi, Jackson, Mississippi., Hirose H; Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania., Engelman DT; Department of Surgery, Baystate Medical Center, Springfield, Massachusetts., Rabin J; Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland., Firstenberg M; Department of Cardiovascular Surgery, The Medical Center of Aurora, Aurora, Colorado., Moosdorf RGH; Department for Cardiovascular Surgery, Phillips University, Marburg, Germany., Geller CM; Division of Cardiothoracic Surgery, Drexel University College of Medicine, Upland, Pennsylvania., Hiebert B; Cardiac Sciences Program, St Boniface Hospital, Winnipeg, Manitoba, Canada., Whitman GJ; Division of Cardiovascular Surgery, Department of Surgery, Johns Hopkins Medical Institute, Baltimore, Maryland.
Jazyk:	angličtina
Zdroj:	The Annals of thoracic surgery [Ann Thorac Surg] 2020 Mar; Vol. 109 (3), pp. 702-710. Date of Electronic Publication: 2019 Aug 15.
DOI:	10.1016/j.athoracsur.2019.06.077
Abstrakt:	Background: Intensive care unit (ICU) structure and intensive care physician staffing (IPS) models are thought to influence outcomes after cardiac surgery. Given limited information on staffing in the cardiothoracic ICU, The Society of Thoracic Surgeons Workforce on Critical Care undertook a survey to describe current IPS models. We hypothesized that variability would exist throughout the United States. Methods: A survey was sent to The Society of Thoracic Surgeons centers in the United States. Center case volume, ICU census, procedure profiles, and the primary specialties of consultants were queried. Definitions of IPS models were open (managed by cardiac surgeons), closed (all decisions made by dedicated intensivists 7 days a week), or semiopen (intensivist attends 5-7 days a week with surgeons cosharing management). Experience level of bedside providers and after-hours provider coverage were also assessed. Results: Of the 965 centers contacted, 148 (15.3%) completed surveys. Approximately 41% of reporting centers used a dedicated cardiothoracic ICU for immediate postoperative management. The most common IPS model was open (47%), followed by semiopen (41%) and closed (12%). The primary specialties of intensivists varied, with pulmonary medicine/critical care being predominant (67%). Physician assistants were the most common after-hours provider (44%). More than one-third of responding centers described having no house staff, other than bedside nurses, for nighttime coverage. Conclusions: Cardiothoracic ICU models vary widely in the United States, with almost half being open, often with no in-house coverage. In-house nighttime coverage was (1) not driven by case complexity and (2) most commonly provided by a physician assistant. Clinical outcomes associated with different ISPS models require further evaluation. (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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