Table 3.
Association between facility-level characteristics and odds of death in 30 days after cardiac surgery in bivariate and multivariable logistic regression models (n=29,449).
| Exposure Variable | Unadjusted OR (95% CI) | P-value | Adjusted OR (95% CI) | P-value |
|---|---|---|---|---|
| Structural attributes | ||||
| ICU dedicated to cardiac surgery | 1.05 (0.92–1.20) | 0.484 | 1.09 (0.84–1.42) | 0.502 |
| NDNQI participation | 0.82 (0.61–1.09) | 0.167 | 0.94 (0.71–1.23) | 0.644 |
| Protocols*: | ||||
| Low tidal volume ventilation** | 0.91 (0.79–1.04) | 0.153 | 0.92 (0.72–1.17) | 0.503 |
| Sedation management | 1.08 (0.93–1.26) | 0.290 | 1.29 (0.98–1.69) | 0.067 |
| Therapeutic hypothermia after cardiac arrest | 1.30 (1.03–1.63) | 0.025 | 1.19 (0.73–1.95) | 0.477 |
| Liberation from mechanical ventilation | 0.98 (0.79–1.21) | 0.840 | 0.89 (0.70–1.13) | 0.345 |
| Respiratory therapists participate in daily rounds | 0.89 (0.78–1.02) | 0.105 | 0.92 (0.70–1.22) | 0.571 |
| Pharmacists participate in daily rounds | 0.84 (0.73–0.96) | 0.012 | 0.89 (0.70–1.12) | 0.317 |
| Presence of nurse practitioners or physician assistants | 1.05 (0.82–1.34) | 0.715 | 1.00 (0.76–1.32) | 0.999 |
| Telemedicine access | 0.81 (0.70–0.95) | 0.007 | 0.87 (0.67–1.13) | 0.295 |
| Nursing attributes | ||||
| Proportion of nurses with <2 years ICU experience***: | ||||
| <1/3 (more experienced) | Referent | Referent | ||
| >1/3 (less experienced) | 1.18 (1.04–1.33) | 0.008 | 1.20 (0.97–1.47) | 0.090 |
| Proportion of nurses with BSN degree | ||||
| <1/3 (more experienced) | Referent | Referent | ||
| >1/3 (less experienced) | 1.13 (0.83–1.54) | 0.424 | 0.94 (0.76–1.17) | 0.593 |
| Physician attributes | ||||
| Presence of daytime intensivist | 1.21 (1.06–1.38) | 0.005 | 1.12 (0.89–1.40) | 0.351 |
| Nighttime attending staffing: | ||||
| No nighttime attending | Referent | Referent | ||
| Non-intensivist nighttime attending | 1.09 (0.94–1.26) | 0.255 | 0.91 (0.71–1.16) | 0.439 |
| Intensivist nighttime attending | 0.90 (0.74–1.09) | 0.268 | 0.85 (0.65–1.12) | 0.259 |
| Presence of interns or residents | 1.75 (1.51–2.04) | <0.001 | 1.34 (0.98–1.82) | 0.066 |
| Presence of fellows | 1.61 (1.39–1.87) | <0.001 | 1.25 (0.89–1.76) | 0.196 |
CI: confidence interval; OR: odds ratio. Multivariable models accounted for patient clustering within ICUs and controlled for patient age, sex, race, Charlson comorbidity score, insurance type, admission source, and surgery type. Odds ratios less than 1 indicate a lower risk of death in the 30 days after surgery.
Use of a protocol for central line insertion was excluded from multivariable analysis due to low numbers of ICUs not reporting use of this protocol type.
ICU uses a protocol for low tidal volumes in mechanically ventilated patients with acute respiratory distress syndrome.
Refers to nurses working during weekday shifts.