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- Title
ICU staffing feature phenotypes and their relationship with patients' outcomes: an unsupervised machine learning analysis.
- Authors
Zampieri, Fernando G.; Salluh, Jorge I. F.; Azevedo, Luciano C. P.; Kahn, Jeremy M.; Damiani, Lucas P.; Borges, Lunna P.; Viana, William N.; Costa, Roberto; Corrêa, Thiago D.; Araya, Dieter E. S.; Maia, Marcelo O.; Ferez, Marcus A.; Carvalho, Alexandre G. R.; Knibel, Marcos F.; Melo, Ulisses O.; Santino, Marcelo S.; Lisboa, Thiago; Caser, Eliana B.; Besen, Bruno A. M. P.; Bozza, Fernando A.
- Abstract
<bold>Purpose: </bold>To study whether ICU staffing features are associated with improved hospital mortality, ICU length of stay (LOS) and duration of mechanical ventilation (MV) using cluster analysis directed by machine learning.<bold>Methods: </bold>The following variables were included in the analysis: average bed to nurse, physiotherapist and physician ratios, presence of 24/7 board-certified intensivists and dedicated pharmacists in the ICU, and nurse and physiotherapist autonomy scores. Clusters were defined using the partition around medoids method. We assessed the association between clusters and hospital mortality using logistic regression and with ICU LOS and MV duration using competing risk regression.<bold>Results: </bold>Analysis included data from 129,680 patients admitted to 93 ICUs (2014-2015). Three clusters were identified. The features distinguishing between the clusters were: the presence of board-certified intensivists in the ICU 24/7 (present in Cluster 3), dedicated pharmacists (present in Clusters 2 and 3) and the extent of nurse autonomy (which increased from Clusters 1 to 3). The patients in Cluster 3 exhibited the best outcomes, with lower adjusted hospital mortality [odds ratio 0.92 (95% confidence interval (CI), 0.87-0.98)], shorter ICU LOS [subhazard ratio (SHR) for patients surviving to ICU discharge 1.24 (95% CI 1.22-1.26)] and shorter durations of MV [SHR for undergoing extubation 1.61(95% CI 1.54-1.69)]. Cluster 1 had the worst outcomes.<bold>Conclusion: </bold>Patients treated in ICUs combining 24/7 expert intensivist coverage, a dedicated pharmacist and nurses with greater autonomy had the best outcomes. All of these features represent achievable targets that should be considered by policy makers with an interest in promoting equal and optimal ICU care.
- Subjects
BRAZIL; HOSPITAL mortality; MACHINE learning; PHARMACISTS; LOGISTIC regression analysis; ODDS ratio; NURSES; WORKING hour statistics; HOSPITAL utilization statistics; CLUSTER analysis (Statistics); HEALTH status indicators; LENGTH of stay in hospitals; WORKING hours; INTENSIVE care units; PHYSICIANS; TIME; RETROSPECTIVE studies
- Publication
Intensive Care Medicine, 2019, Vol 45, Issue 11, p1599
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-019-05790-z