News Blog readers will know that a study associated with CLAHRC WM is evaluating the effect on excess mortality among patients admitted over the weekend. This prospective study, led by CLAHRC WM Leadership Fellow Julian Bion, is making use of a ‘natural experiment’ as hospitals increase consultant presence at different rates. A similar study has examined the effect of gradual increase in intensivist staffing in American intensive care units. An association at baseline between intensivist staffing and mortality was found. But hospitals “that adopted intensivist staffing during the study period did not substantially improve their mortality rates.” The relative risk was 0.96 (0.90 – 1.02) on the difference-in-difference measure. An observer with a symmetrical prior centred on a 4% difference in the difference would, of course, be able to cling onto that 4% effect size. If all adverse events were reduced in proportion, would this be cost-effective at the nominal US willingness-to-pay threshold for a year of healthy life of about $100,000. The CLAHRC WM Director feels a modelling study coming on. But here is a back-of-the-envelope calculation. ITU mortality in the US is about 12%. This could be reduced by 4% to about 0.5%, or about five lives in a thousand ITU admissions. That amount to around 50 life years if the mean life expectancy of a life saved is 10 years. Fifty life years represents an (undiscounted) expected benefit of $5,000,000. Any less and the extra intensivists would represent poor value for money.
— Richard Lilford, CLAHRC WM Director
- Nagendran M, Dimick JB, Gonzalez AA, Birkmeyer JD, Ghaferi AA. Mortality Among Older Adults Before Versus After Hospital Transition to Intensivist Staffing. Med Care. 2016; 54(1): 67-73.
- Zimmerman JE, Kramer AA, Knaus WA. Changes in Hospital Mortality for United States Intensive Care Unit Admissions from 1988 to 2012. Crit Care. 2013; 17: R81.