• Meghan B Lane-Fall, Tara S Ramaswamy, Sydney E S Brown, Xu He, Jacob T Gutsche, Lee A Fleisher, and Mark D Neuman.
• 1Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 2Penn Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania, Philadelphia, PA. 3Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. 4Penn Center for Healthcare Improvement and Patient Safety, University of Pennsylvania, Philadelphia, PA. 5Christiana Care Health System Value Institute, Newark, DE. 6Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program, Philadelphia, PA. 7Stanford Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Palo Alto, CA. 8Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, OH.
• Crit. Care Med. 2017 Sep 1; 45 (9): 1472-1480.

ObjectiveCardiac surgery ICU characteristics and clinician staffing patterns have not been well characterized. We sought to describe Pennsylvania cardiac ICUs and to determine whether ICU characteristics are associated with mortality in the 30 days after cardiac surgery.DesignFrom 2012 to 2013, we conducted a survey of cardiac surgery ICUs in Pennsylvania to assess ICU structure, care practices, and clinician staffing patterns. ICU data were linked to an administrative database of cardiac surgery patient discharges. We used logistic regression to measure the association between ICU variables and death in 30 days.SettingCardiac surgery ICUs in Pennsylvania.PatientsPatients having coronary artery bypass grafting and/or cardiac valve repair or replacement from 2009 to 2011.InterventionsNone.Measurements And Main ResultsOf the 57 cardiac surgical ICUs in Pennsylvania, 43 (75.4%) responded to the facility survey. Rounds included respiratory therapists in 26 of 43 (60.5%) and pharmacists in 23 of 43 (53.5%). Eleven of 41 (26.8%) reported that at least 2/3 of their nurses had a bachelor's degree in nursing. Advanced practice providers were present in most of the ICUs (37/43; 86.0%) but residents (8/42; 18.6%) and fellows (7/43; 16.3%) were not. Daytime intensivists were present in 21 of 43 (48.8%) responding ICUs; eight of 43 (18.6%) had nighttime intensivists. Among 29,449 patients, there was no relationship between mortality and nurse ICU experience, presence of any intensivist, or absence of residents after risk adjustment. To exclude patients who may have undergone transcatheter aortic valve replacement, we conducted a subgroup analysis of patients undergoing only coronary artery bypass grafting, and results were similar.ConclusionsPennsylvania cardiac surgery ICUs have variable structures, care practices, and clinician staffing, although none of these are statistically significantly associated with mortality in the 30 days following surgery after adjustment.

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