Survey of Contemporary Cardiac Surgery ICU Models in the United States
Intensive care unit (ICU) structure and intensive care physician staffing (IPS) models are thought to influence outcomes following 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.
A survey was sent to STS centers in the United States. Center case volume, ICU census, procedure profiles and the primary specialties of consultants were queried. Definitions of intensive care physician staffing models were: "open" (managed by cardiac surgeons), closed (all decisions made by dedicated intensivists 7 days a week.) or semi-open (intensivist attends 5-7 days a week with surgeons co-sharing management). Experience level of bedside providers, and after-hours provider coverage were also assessed.
Of the 965 centers contacted, 148 (15.3%) completed surveys. Approximately 41% of reporting centers utilized a dedicated cardiothoracic ICU for immediate postoperative management. The most common intensive care physician staffing model was open (47%), followed by semi-open (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.
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 a) not driven by case complexity, and b) most commonly provided by a physician assistant. Clinical outcomes associated with different ISPS models require further evaluation.
Arora RC, Chatterjee S, Shake JG, Hirose H, Engelman DT, Rabin J, Firstenberg M, Moosdorf RGH, Geller CM, Hiebert B, Whitman GJ; Society of Thoracic Surgery Workforce for Critical Care (STS WFCC). Survey of Contemporary Cardiac Surgery ICU Models in the United States. Ann Thorac Surg. 2019 Aug 14.