Impact of resident rotations on critically Ill patient outcomes: Results of a French multicenter observational study

Benjamin G. Chousterman; Romain Pirracchio; Bertrand Guidet; Philippe Aegerter; Herve Mentec; P. Trouiller; J. P. Bedos; A. Vieillard-Baron; Y. Cohen; J. Labrousse; M. Safar; C. Richard; M. Wolff; G. Choukroun; J. P. Mira; B. Verdière; P. Kalfon; J. Y. Fagon; P. Ho; C. Brun-Buisson; A. Rabbat; F. Blot; C. Baillard; D. Dreyfus; F. Baud; C. Bornstain; L. Pallot; H. Bismuth; T. Similowski; J. Chastre; F. Bolgert; J. L. Ricome; H. Outin; F. Santoli; D. Annane; B. Misset; B. Schlemmer; L. Jacob; M. Fartoukh; F. Bonnet

doi:10.1371/journal.pone.0162552

Impact of resident rotations on critically Ill patient outcomes: Results of a French multicenter observational study

Benjamin G. Chousterman, Romain Pirracchio, Bertrand Guidet, Philippe Aegerter, Herve Mentec, P. Trouiller, J. P. Bedos, A. Vieillard-Baron, Y. Cohen, J. Labrousse, M. Safar, C. Richard, M. Wolff, G. Choukroun, J. P. Mira, B. Verdière, P. Kalfon, J. Y. Fagon, P. Ho, C. Brun-BuissonA. Rabbat, F. Blot, C. Baillard, D. Dreyfus, F. Baud, C. Bornstain, L. Pallot, H. Bismuth, T. Similowski, J. Chastre, F. Bolgert, J. L. Ricome, H. Outin, F. Santoli, D. Annane, B. Misset, B. Schlemmer, L. Jacob, M. Fartoukh, F. Bonnet

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Résumé

Purpose The impact of resident rotation on patient outcomes in the intensive care unit (ICU) has been poorly studied. The aim of this study was to address this question using a large ICU database. Methods We retrospectively analyzed the French CUB-REA database. French residents rotate every six months. Two periods were compared: the first (POST) and fifth (PRE) months of the rotation. The primary endpoint was ICU mortality. The secondary endpoints were the length of ICU stay (LOS), the number of organ supports, and the duration of mechanical ventilation (DMV). The impact of resident rotationwas explored using multivariate regression, classification tree and random forest models. Results 262,772 patients were included between 1996 and 2010 in the database. The patient characteristicswere similar between the PRE (n = 44,431) and POST (n = 49,979) periods. Multivariate analysis did not reveal any impact of resident rotation on ICU mortality(OR = 1.01, 95% CI = 0.94; 1.07, p = 0.91). Based on the classification trees, the SAPS II and the number of organ failures were the strongest predictors of ICU mortality. In the less severe patients (SAPS II24), the POST periodwas associated with increased mortality(OR =1.65, 95%CI = 1.17 2.33, p = 0.004). After adjustment, no significant association was observed between the rotation period and the LOS, the number of organ supports, or the DMV. Conclusion Resident rotation exerts no impact on overall ICU mortality at French teaching hospitals but might affect the prognosis of less severe ICU patients. Surveillance should be reinforced when treating those patients.

langue originale	Anglais
Numéro d'article	e0162552
journal	PLoS ONE
Volume	11
Numéro de publication	9
Les DOIs	https://doi.org/10.1371/journal.pone.0162552
état	Publié - 1 sept. 2016

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10.1371/journal.pone.0162552

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Chousterman, B. G., Pirracchio, R., Guidet, B., Aegerter, P., Mentec, H., Trouiller, P., Bedos, J. P., Vieillard-Baron, A., Cohen, Y., Labrousse, J., Safar, M., Richard, C., Wolff, M., Choukroun, G., Mira, J. P., Verdière, B., Kalfon, P., Fagon, J. Y., Ho, P., ... Bonnet, F. (2016). Impact of resident rotations on critically Ill patient outcomes: Results of a French multicenter observational study. PLoS ONE, 11(9), Article e0162552. https://doi.org/10.1371/journal.pone.0162552

@article{283535347ca84fcf8841ed207e00a74c,

title = "Impact of resident rotations on critically Ill patient outcomes: Results of a French multicenter observational study",

abstract = "Purpose The impact of resident rotation on patient outcomes in the intensive care unit (ICU) has been poorly studied. The aim of this study was to address this question using a large ICU database. Methods We retrospectively analyzed the French CUB-REA database. French residents rotate every six months. Two periods were compared: the first (POST) and fifth (PRE) months of the rotation. The primary endpoint was ICU mortality. The secondary endpoints were the length of ICU stay (LOS), the number of organ supports, and the duration of mechanical ventilation (DMV). The impact of resident rotationwas explored using multivariate regression, classification tree and random forest models. Results 262,772 patients were included between 1996 and 2010 in the database. The patient characteristicswere similar between the PRE (n = 44,431) and POST (n = 49,979) periods. Multivariate analysis did not reveal any impact of resident rotation on ICU mortality(OR = 1.01, 95% CI = 0.94; 1.07, p = 0.91). Based on the classification trees, the SAPS II and the number of organ failures were the strongest predictors of ICU mortality. In the less severe patients (SAPS II24), the POST periodwas associated with increased mortality(OR =1.65, 95%CI = 1.17 2.33, p = 0.004). After adjustment, no significant association was observed between the rotation period and the LOS, the number of organ supports, or the DMV. Conclusion Resident rotation exerts no impact on overall ICU mortality at French teaching hospitals but might affect the prognosis of less severe ICU patients. Surveillance should be reinforced when treating those patients.",

author = "Chousterman, {Benjamin G.} and Romain Pirracchio and Bertrand Guidet and Philippe Aegerter and Herve Mentec and P. Trouiller and Bedos, {J. P.} and A. Vieillard-Baron and Y. Cohen and J. Labrousse and M. Safar and C. Richard and M. Wolff and G. Choukroun and Mira, {J. P.} and B. Verdi{\`e}re and P. Kalfon and Fagon, {J. Y.} and P. Ho and C. Brun-Buisson and A. Rabbat and F. Blot and C. Baillard and D. Dreyfus and F. Baud and C. Bornstain and L. Pallot and H. Bismuth and T. Similowski and J. Chastre and F. Bolgert and Ricome, {J. L.} and H. Outin and F. Santoli and D. Annane and B. Misset and B. Schlemmer and L. Jacob and M. Fartoukh and F. Bonnet",

note = "Publisher Copyright: {\textcopyright} 2016 Chousterman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2016",

month = sep,

day = "1",

doi = "10.1371/journal.pone.0162552",

language = "English",

volume = "11",

journal = "PLoS ONE",

issn = "1932-6203",

number = "9",

}

Chousterman, BG, Pirracchio, R, Guidet, B, Aegerter, P, Mentec, H, Trouiller, P, Bedos, JP, Vieillard-Baron, A, Cohen, Y, Labrousse, J, Safar, M, Richard, C, Wolff, M, Choukroun, G, Mira, JP, Verdière, B, Kalfon, P, Fagon, JY, Ho, P, Brun-Buisson, C, Rabbat, A, Blot, F, Baillard, C, Dreyfus, D, Baud, F, Bornstain, C, Pallot, L, Bismuth, H, Similowski, T, Chastre, J, Bolgert, F, Ricome, JL, Outin, H, Santoli, F, Annane, D, Misset, B, Schlemmer, B, Jacob, L, Fartoukh, M & Bonnet, F 2016, 'Impact of resident rotations on critically Ill patient outcomes: Results of a French multicenter observational study', PLoS ONE, VOL. 11, Numéro 9, e0162552. https://doi.org/10.1371/journal.pone.0162552

TY - JOUR

T1 - Impact of resident rotations on critically Ill patient outcomes

T2 - Results of a French multicenter observational study

AU - Chousterman, Benjamin G.

AU - Pirracchio, Romain

AU - Guidet, Bertrand

AU - Aegerter, Philippe

AU - Mentec, Herve

AU - Trouiller, P.

AU - Bedos, J. P.

AU - Vieillard-Baron, A.

AU - Cohen, Y.

AU - Labrousse, J.

AU - Safar, M.

AU - Richard, C.

AU - Wolff, M.

AU - Choukroun, G.

AU - Mira, J. P.

AU - Verdière, B.

AU - Kalfon, P.

AU - Fagon, J. Y.

AU - Ho, P.

AU - Brun-Buisson, C.

AU - Rabbat, A.

AU - Blot, F.

AU - Baillard, C.

AU - Dreyfus, D.

AU - Baud, F.

AU - Bornstain, C.

AU - Pallot, L.

AU - Bismuth, H.

AU - Similowski, T.

AU - Chastre, J.

AU - Bolgert, F.

AU - Ricome, J. L.

AU - Outin, H.

AU - Santoli, F.

AU - Annane, D.

AU - Misset, B.

AU - Schlemmer, B.

AU - Jacob, L.

AU - Fartoukh, M.

AU - Bonnet, F.

N1 - Publisher Copyright: © 2016 Chousterman et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Purpose The impact of resident rotation on patient outcomes in the intensive care unit (ICU) has been poorly studied. The aim of this study was to address this question using a large ICU database. Methods We retrospectively analyzed the French CUB-REA database. French residents rotate every six months. Two periods were compared: the first (POST) and fifth (PRE) months of the rotation. The primary endpoint was ICU mortality. The secondary endpoints were the length of ICU stay (LOS), the number of organ supports, and the duration of mechanical ventilation (DMV). The impact of resident rotationwas explored using multivariate regression, classification tree and random forest models. Results 262,772 patients were included between 1996 and 2010 in the database. The patient characteristicswere similar between the PRE (n = 44,431) and POST (n = 49,979) periods. Multivariate analysis did not reveal any impact of resident rotation on ICU mortality(OR = 1.01, 95% CI = 0.94; 1.07, p = 0.91). Based on the classification trees, the SAPS II and the number of organ failures were the strongest predictors of ICU mortality. In the less severe patients (SAPS II24), the POST periodwas associated with increased mortality(OR =1.65, 95%CI = 1.17 2.33, p = 0.004). After adjustment, no significant association was observed between the rotation period and the LOS, the number of organ supports, or the DMV. Conclusion Resident rotation exerts no impact on overall ICU mortality at French teaching hospitals but might affect the prognosis of less severe ICU patients. Surveillance should be reinforced when treating those patients.

AB - Purpose The impact of resident rotation on patient outcomes in the intensive care unit (ICU) has been poorly studied. The aim of this study was to address this question using a large ICU database. Methods We retrospectively analyzed the French CUB-REA database. French residents rotate every six months. Two periods were compared: the first (POST) and fifth (PRE) months of the rotation. The primary endpoint was ICU mortality. The secondary endpoints were the length of ICU stay (LOS), the number of organ supports, and the duration of mechanical ventilation (DMV). The impact of resident rotationwas explored using multivariate regression, classification tree and random forest models. Results 262,772 patients were included between 1996 and 2010 in the database. The patient characteristicswere similar between the PRE (n = 44,431) and POST (n = 49,979) periods. Multivariate analysis did not reveal any impact of resident rotation on ICU mortality(OR = 1.01, 95% CI = 0.94; 1.07, p = 0.91). Based on the classification trees, the SAPS II and the number of organ failures were the strongest predictors of ICU mortality. In the less severe patients (SAPS II24), the POST periodwas associated with increased mortality(OR =1.65, 95%CI = 1.17 2.33, p = 0.004). After adjustment, no significant association was observed between the rotation period and the LOS, the number of organ supports, or the DMV. Conclusion Resident rotation exerts no impact on overall ICU mortality at French teaching hospitals but might affect the prognosis of less severe ICU patients. Surveillance should be reinforced when treating those patients.

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DO - 10.1371/journal.pone.0162552

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VL - 11

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