Care of critically ill pediatric patients by hospitalists is associated with improved survival

INTRODUCTION Studies have indicated that critically ill pediatric patients admitted to intensive care units of teaching hospitals and cared for by residents have significantly increased mortality when compared to pediatric intensive care units without residents. At our institution, we now rely on pediatric hospitalists rather than pediatric residents for after-hours coverage of our level I intensive care unit when a pediatric intensivist is not in-house. Our objective was to compare the odds of survival of patients admitted to the pediatric ICU during the periods when residents versus hospitalists were responsible for in-house coverage of the pediatric ICU. METHODS We reviewed medical records of patients admitted to our unit and cared for by residents for a period of one year and for patients cared for by hospitalists for a period of one year to obtain demographic data, diagnoses, PRISM scores, length of stay in the intensive care unit, and deaths. We used logistic regression to compare odds of survival during the two periods, adjusted for possible confounders including age, diagnostic category, and severity of illness as measured by PRISM scores. Linear regression was used to compare length of stay during the two periods, adjusted for the same confounders. RESULTS The estimated odds ratio for survival during the year that hospitalists cared for patients in the intensive care unit was 2.7 times better than the previous year when residents were involved in their care. This difference was significant (p = 0.017) and was independent of age, severity of illness, and diagnostic category. Length of stay during the hospitalist year was shorter by 1.15 days compared to the resident year and was nearly statistically significant (p = .087) and was also independent of age, diagnostic category, and severity of illness. CONCLUSIONS Our study suggests that patients admitted to a teaching hospital intensive care unit have better odds of survival when cared for by a hospitalist rather than a resident during the hours when an intensivist is not in-house. There is also a strong trend toward shorter stays in the intensive care unit with hospitalists in-house.