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Impact of Leadership of Trained Intensivist in Pediatric Intensive Care Unit in a Middle Income Country: An Uncontrolled Before-After Study

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Abstract

Objective

To evaluate the effects generated by an intensivist in pediatric intensive care unit (PICU) on the process of care and patient outcomes.

Methods

This study was a retrospective observational study conducted in the 16-bedded PICU of a tertiary referral center. Two years (2013–2015) period of the PICU without an intensivist and the following two years (2015–2017) when it was attended by an intensivist who was also the first ever graduate of the fellowship program in Turkey were compared.

Results

Number of patients followed in PICU increased more than 2-fold. Number of mechanically ventilated patients increased more than 2-folds and presence of intensivist reduced the mechanical ventilation duration by 59%. Presence of intensivist reduced the mortality rates by 2.18 times. It was shown that management of PICU beds by an intensivist resulted in increased number of patients per year per PICU bed, increased care of true critical care patients who are in need of more intensive therapies and invasive procedures including extracorporeal treatment options, decreased length of stay, decreased number and rate of nosocomial infections, and decreased mortality rate.

Conclusions

What transforms a unit full of critically ill patients to an intensive care unit is a dedicated intensivist. The current study demonstrated that intensivist is the crucial component of the PICUs.

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Acknowledgments

The authors thank Gülin Gökcen Kesici for statistical analysis. The authors thank Seval Altunkeser, the chief nurse of the PICU during the study period, for dedicated support in patient care.

Author information

SK and BB collected the data, wrote and reviewed the manuscript. BB is the guarantor for this paper.

Correspondence to Selman Kesici.

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Kesici, S., Bayrakci, B. Impact of Leadership of Trained Intensivist in Pediatric Intensive Care Unit in a Middle Income Country: An Uncontrolled Before-After Study. Indian J Pediatr (2020). https://doi.org/10.1007/s12098-019-03154-5

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Keywords

  • Intensivist
  • Pediatric intensive care unit
  • Outcome