Intubating intensivists decrease emergency physician and anesthesiologist interruptions: a single-site retrospective cohort study

Background: Endotracheal intubation (ETI) is a life-saving procedure in the intensive care unit (ICU) and may be performed by intensivists, emergency physicians, anesthesiologists or nurse anesthetists, or respiratory therapists, depending on the staffing model of the hospital. However, little is known about who performs ETI in community hospitals, nor the impact of the proceduralist on other clinicians in the hospital. We hypothesized that implementing an intubating intensivist into the staffing model of the ICU would decrease the proportion of intubations performed by a non-intensivist, thereby decreasing interruptions to the emergency physician and anesthesiologist. Methods: We performed a retrospective analysis of intubations performed at a community hospital before and after the implementation of intubating intensivists using a pre- and post-retrospective cohort. All patients admitted to the ICU who had a documented ETI were eligible for inclusion. We compared proportions of intubations completed by intensivists versus non-intensivists using the chi square test and further stratified by primary medical specialty during a one-year period without intubating intensivists and a one-year period following the implementation of intubating intensivists. Results: A total of 134 intubations were included, with 79 during the pre-intervention period and 55 during the post-intervention period. In the pre-intervention period 78 (98.7%) of the intubations were performed by a non-intensivist, while in the post-intubation period 39 (70.9%) were performed by a non-intensivist. The greatest decreases were seen during daytime hours, with a 40% absolute decrease in non-intensivist performed intubations from 7 am to 5 pm (100% to 60%; P<0.001) and a 67% absolute decrease from 5 pm to 7 pm (100% to 33.3%; P=0.014). There was no difference in intubations at night by specialty (P=0.32). Conclusions: Implementation of intubating intensivists at a community hospital significantly decreased the proportions of intubations performed by non-intensivist physicians, particularly during daytime hours, suggesting a decrease in interruptions experienced by emergency physicians and anesthesiologists. Community hospitals with ICUs may choose to implement an intubating intensivist model to reduce reliance on other non-intensivist clinicians to perform ETIs. If a non-intubating intensivist model is chosen, hospitals should be aware of the interruptions placed on the clinician required to intubate in the ICU.