Two Weeks Versus One Week of Maximal Patient-Intensivist Continuity for Adult Medical Intensive Care Patients: A Two-Center Target Trial Emulation.

Objectives: To compare outcomes for 2 weeks vs. 1 week of maximal patient-intensivist continuity in the ICU.
Design: Retrospective cohort study.
Setting: Two U.S. urban, teaching, medical ICUs where intensivists were scheduled for 2-week service blocks: site A was in the Midwest and site B was in the Northeast.
Patients: Patients 18 years old or older admitted to a study ICU between March 1, 2017, and February 28, 2020.
Interventions: None.
Measurements and Main Results: We applied target trial emulation to compare admission during an intensivist's first week (as a proxy for 2 wk of maximal continuity) vs. admission during their second week (as a proxy for 1 wk of maximal continuity). Outcomes included hospital mortality, ICU length of stay, and, for mechanically ventilated patients, duration of ventilation. Exploratory outcomes included imaging, echocardiogram, and consultation orders. We used inverse probability weighting to adjust for baseline differences and random-effects meta-analysis to calculate overall effect estimates. Among 2571 patients, 1254 were admitted during an intensivist's first week and 1317 were admitted during a second week. At sites A and B, hospital mortality rates were 25.8% and 24.2%, median ICU length of stay were 4 and 2 days, and median mechanical ventilation durations were 3 and 3 days, respectively. There were no differences in adjusted mortality (odds ratio [OR], 1.01 [95% CI, 0.96-1.06]) or ICU length of stay (-0.25 d [-0.82 d to +0.32 d]) for 2 weeks vs. 1 week of maximal continuity. Among mechanically ventilated patients, there were no differences in adjusted mortality (OR, 1.00 [0.87-1.16]), ICU length of stay (+0.06 d [-0.78 d to +0.91 d]), or duration of mechanical ventilation (+0.37 d [-0.46 d to +1.21 d]) for 2 weeks vs. 1 week of maximal continuity.
Conclusions: Two weeks of maximal patient-intensivist continuity was not associated with differences in clinical outcomes compared with 1 week in two medical ICUs.
Competing Interests: Drs. Admon’s, Gershengorn’s, and Prescott’s institutions received funding from the National Heart, Lung, and Blood Institute. Drs. Admon, Law, and Valley received support for article research from the National Institutes of Health (NIH). Dr. Admon was funded by K08HL155407. Dr. Law’s institution received funding from the NIH. Dr. Gershengorn’s institution received funding from the Canadian Institutes for Health Research; she received funding from CHEST Critical Care, Annals of the American Thoracic Society, International Symposium on Intensive Care and Emergency Medicine, and Southeastern Critical Care Summit; and she received support from the University of Miami Hospital and Clinics Data Analytics Research Team. Dr. Prescott’s institution received funding from the Agency for Healthcare Research and Quality, Veterans Affairs Health Services Research and Development, the Centers for Disease Control and Prevention, and Blue Cross Blue Shield of Michigan; she disclosed government work. The remaining authors have disclosed that they do not have any potential conflicts of interest.
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