Dividing intensive care specialists according to their backgrounds is not useful to improve quality in intensive care.docVIP

Braun and Spies Critical Care 2010,14:409 /content/14/2/409 LET TER Dividing intensive care specialists according to their backgrounds is not useful to improve quality in intensive care Jan-Peter Braun* and Claudia Spies See related research by Billington et al., /content/13/6/R209 We have some strong concerns regarding the principle message in Billington and colleagues’ article [1] – namely, Fourth, there is no information regarding variation in surgical versus nonsurgical patients, the times to stabi li sa tion that intensivists’ base speciality of training may be in the emergency room and, ? nally, procedural or structural associated with variations in practice patterns and out- di? erences between the various institutions involved. come in critical care patients. We caution against propa- Finally, the authors observed no di? erences in patients’ gat ing the concept of dividing intensive care specialists length of ICU stay, or in hospital mortality or hospital according to their backgrounds. length of stay. Without information regarding scores at discharge, we consider drawing conclusions based simply on ICU mortality ? gures to be problematic. Some methodological weaknesses in the paper are as follows. First, the impact of nursing factors was not considered. Speci? cally, the standardised mortality rate was higher in intensive care units (ICUs) with lower numbers of nurses Conclusion e authors themselves remind us that ‘our results should only be viewed as hypothesis-generating given the retro- spective design of the study’ [1]. We are concerned that per be e quality of invasive procedures will also be greatly impacted by nursing practices. Second, there was very signi? cant variation in size this potentially divisive hypothesis is not founded on between the three ICUs involved in the study ere is sound evidence, and we have attempted