ICU physician-based determinants of life-sustaining therapy during nights and weekends: french multicenter study from the Outcomerea research group

Garrouste-Orgeas, Maite, Ben-Rehouma, Mouna, Darmon, Michael, Ruckly, Stephane, Clec'h, Christophe, Adrie, Christophe, Tabah, Alexis, Vesin, Aurelien, Schwebel, Carole, Misset, Benoit and Timsit, Jean-Francois (2014) ICU physician-based determinants of life-sustaining therapy during nights and weekends: french multicenter study from the Outcomerea research group. Critical Care Medicine, 42 11: 2393-2400. doi:10.1097/CCM.0000000000000523


Author Garrouste-Orgeas, Maite
Ben-Rehouma, Mouna
Darmon, Michael
Ruckly, Stephane
Clec'h, Christophe
Adrie, Christophe
Tabah, Alexis
Vesin, Aurelien
Schwebel, Carole
Misset, Benoit
Timsit, Jean-Francois
Title ICU physician-based determinants of life-sustaining therapy during nights and weekends: french multicenter study from the Outcomerea research group
Journal name Critical Care Medicine   Check publisher's open access policy
ISSN 0090-3493
1530-0293
Publication date 2014-11
Year available 2014
Sub-type Article (original research)
DOI 10.1097/CCM.0000000000000523
Open Access Status Not Open Access
Volume 42
Issue 11
Start page 2393
End page 2400
Total pages 8
Place of publication Philadelphia, PA, United States
Publisher Lippincott Williams & Wilkins
Language eng
Formatted abstract
Objective: Patient- and organization-related factors are the most common influences affecting the ICU decision-making process. Few studies have investigated ICU physician-related factors and life-sustaining treatment use during nights and weekends, when staffing ratios are low. Here, we described patients admitted during nights/weekends and looked for physician-related determinants of life-sustaining treatment use in these patients after adjustment for patient- and center-related factors.

Design: Multicenter observational cohort study of admission procedures during nights/weekends shifts.

Subjects: ICU physicians working nights/weekends in 6 French ICUs.

Interventions: None.

Measurements and Main Results: Patient characteristics and intensity of care were extracted from the prospective Outcomerea database. Physician characteristics were age, gender, religion and religiosity, ICU experience, specialty, being a permanent ICU staff member, degree in ethics, and degree in intensive care. We used hierarchical mixed models to adjust on center, physician random effects, and admission patient characteristics. Of 156 physicians contacted, 119 (77%) participated. Patients admitted during nights/weekends were younger and had fewer comorbidities and lower treatment intensity during the shift. ICU physicians who are younger than 35 years used more renal replacement therapy (odds ratio, 1.04; 95% CI, 1-1.07; p = 0.04), invasive mechanical ventilation (odds ratio, 1.09; 95% CI, 1.1-1.19; p = 0.04), and vasopressors (odds ratio, 1.16; 95% CI, 1.09-1.23; p < 0.0001). Internal or emergency medicine as the primary specialty was associated with invasive mechanical ventilation (odds ratio, 1.14; 95% CI, 1.04-1.24; p = 0.004) and vasopressor use (odds ratio, 1.09; 95% CI, 1.02-1.17; p = 0.01). Noninvasive ventilation was used less often by physicians with more than 10 years of night/weekend shifts and more often by those with religious beliefs (odds ratio, 1.05; 95% CI, 1.01-1.08; p = 0.008).

Conclusions: Patients admitted during nights/weekends were younger and had fewer comorbidities. Age, specialty, ICU experience, and religious beliefs of the physicians were significantly associated life-sustaining treatments used.
Keyword Behavior and behavior mechanisms
Decision making
Intensive care unit
Life support care
Physicians
Triage
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Mon, 20 Jun 2016, 17:16:26 EST by Alexs Tabah on behalf of Learning and Research Services (UQ Library)