내과계 중환자실 전공의 수와 중환자실 사망률의 관련성
The number of resident physicians and the mortality rate in a medical intensive care unit
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목적: 중환자실 환자의 치료 성적에 영향을 주는 의료진에는 전문의인 중환자 전담의사뿐만 아니라 전공의도 포함된다. 따라서 저자들은 내과계 중환자실 전담 전공의의 수와 중환자실 사망률의 관계를 분석하였다. 방법: 2005년 1월부터 2009년 12월까지 일개 수련병원의 개방형 내과계 중환자실에서 자료를 후향적으로 분석하였다. 중환자실 전담 전공의가 2명이었던 기간과 2명 미만이었던 기간으로 구분하여 두 기간의 월별 중환자실 사망률을 비교하였다. 또한 연도와 월을 보정하여 전공의 수가 2명 미만인 경우와 전공의 1인당 중환자실 환자-재원일수가 중환자실 사망에 미치는 영향을 포아송 회귀분석을 통해 확인하였다. 결과: 중환자실 전담 전공의가 2명 미만이었던 기간은 전공의가 2명이었던 기간에 비하여 중환자실 사망률이 높은경향을 보였으나 통계적 차이는 없었다. 연도와 달을 보정한 다변수 포아송 회귀분석에서는 전공의가 2명 미만인 것은전공의가 2명이었던 것에 비하여 중환자실 사망 위험이 유의하게 높았다(incidence risk ratio, IRR, 1.59; 95% CI, 1.05-2.41;p=0.029). 그러나 전공의 1인당 환자-재원일수는 중환자실 사망과 유의한 관련성이 확인되지 않았다(IRR 1.00, 95% CI 0.99-1.01, p=0.649). 결론: 내과계 중환자실 전공의가 2명 미만인 경우 중환자실 사망 위험이 유의하게 높았다. 반면, 전공의 1인당 중환자실 환자 재원일수는 중환자실 사망 위험과 유의한 관련성이 없었다.
Abstract
Background/Aims: The treatment outcome of patients hospitalized in intensive care units (ICUs) can be influenced by physician factors, including both intensivists and resident physicians. We evaluated the association between the number of residents who are exclusively responsible for the ICU and the mortality rate in a medical ICU. Methods: The data obtained from an open medical ICU in a teaching hospital from Jan. 2005 to Dec. 2009 were analyzed retrospectively. We evaluated the associations between the ICU mortality rate and both the number of resident physicians and the number of patient-days per resident physician using multivariate Poisson regression analysis adjusted for year and month. Results: The months with fewer than two residents tended to have a higher ICU mortality rate, although this difference was not significant in the univariate analyses. Multivariate Poisson regression analysis showed that months with fewer than two residents had a significantly higher ICU mortality rate compared with months with two residents (incidence risk ratio (IRR) 1.59, 95% confidence interval (CI) 1.05-2.41; p=0.029). The number of ICU patient-days per resident physician was not associated with the ICU mortality rate (IRR; 1.00, 95% CI, 0.99-1.01; p=0.649). Conclusions: The presence of fewer than two residents exclusively responsible for the medical ICU was an independent risk factor of a higher ICU mortality rate. However, no association was found between the number of ICU patient-days per resident physician and the ICU mortality rate.
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