The effect of prompt physician visits on intensive care unit mortality and cost

Milo Engoren
Critical Care Medicine 2005, 33 (4): 727-32

OBJECTIVE: To determine the effect on mortality, length of stay, and direct variable cost of physician response time to seeing patients after intensive care unit admission.

DESIGN: Retrospective analysis of the intensive care unit database.

SETTING: Medical center.

PATIENTS: Subjects were 840 patients who had complete direct variable cost data and a subset of 316 patients who were matched by propensity scores.


MEASUREMENTS AND MAIN RESULTS: Median time to first visit by a physician was 6 hrs. One hundred thirty-five patients (16.1%) died in hospital compared with 25.0% predicted by Acute Physiology and Chronic Health Evaluation risk (p < .001). Higher Acute Physiology and Chronic Health Evaluation risk, older age, mechanical ventilation on arrival in the intensive care unit, and longer time until seen by a physician were predictors of hospital mortality. Each 1-hr delay in seeing the patient was associated with a 1.6% increased risk of hospital death, which further increased to 2.1% after including propensity score. However, patients seen more promptly (<6 vs. >6 hrs) had greater hospital direct variable cost ($11,992 +/- $12,043 vs. $10,355 +/- $10,368, p = .04), before controlling for acuity of illness and other factors that may have affected time to evaluation. In the subpopulation of propensity-matched patients, patients seen promptly (<6 vs. >6 hrs) had shorter hospital length of stays (11 +/- 11 vs. 13 +/- 14 days, p = .03) but similar direct variable costs ($10,963 +/- 10,778 vs. $13,016 +/- 13,006, p = .16) and similar mortality rates (24 vs. 30, p = .46).

CONCLUSIONS: In the total patient population, delay in seeing patients was associated with an increased risk of death. In the propensity-matched patients, promptly seen patients had shorter hospital stays but similar direct variable costs.

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