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The effect of different intensivist staffing patterns on the rate of potential drug–drug interactions in adult trauma intensive care units

BACKGROUND: Drug–drug interactions (DDIs) have created alarming challenges for public health, especially in those admitted to intensive care units (ICUs). Many studies have shown that involvement of intensivists in the ICUs improves the outcome and decreases the treatment costs. The effect of academ...

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Autores principales: Masjedi, Mansoor, Mirjalili, Mahtabalsadat, Mirzaei, Ehsan, Mirzaee, Hadis, Vazin, Afsaneh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780171/
https://www.ncbi.nlm.nih.gov/pubmed/33447355
http://dx.doi.org/10.1177/2042098620980640
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author Masjedi, Mansoor
Mirjalili, Mahtabalsadat
Mirzaei, Ehsan
Mirzaee, Hadis
Vazin, Afsaneh
author_facet Masjedi, Mansoor
Mirjalili, Mahtabalsadat
Mirzaei, Ehsan
Mirzaee, Hadis
Vazin, Afsaneh
author_sort Masjedi, Mansoor
collection PubMed
description BACKGROUND: Drug–drug interactions (DDIs) have created alarming challenges for public health, especially in those admitted to intensive care units (ICUs). Many studies have shown that involvement of intensivists in the ICUs improves the outcome and decreases the treatment costs. The effect of academic versus non-academic (therapeutic) intensivist as well as hours of coverage and attendance of intensivist on potential DDIs (pDDIs) was evaluated in six adult trauma ICUs of a level one trauma center. METHODS: In this 6-month cross-sectional study, 200 patients were included. The DDIs were classified into five groups, including type A, B, C, D, and X. pDDIs were defined as interactions belonged to C, D and X categories. Patients in six adult ICUs with three different patterns of intensivist staffing models including type A (once-daily therapeutic intensivist visit followed by 24 h on-call), B (twice-daily academic intensivist visit, 8 h of attendance in ICU and 16 h on-call) and C (all criteria just like ICU type B, except for the presence of therapeutic instead of academic intensivist) were screened for pDDIs. RESULTS: In total, 3735 drug orders and 3869 drugs (193 different types) were screened and 1826 pDDIs were identified. Type C, D and X interactions accounted for 60.6%, 35.5%, and 3.9% of all pDDIs, respectively. The mean of pDDI per patient was significantly higher (p-value < 0.001) in the ICU type A than ICU types C and B. The frequency of pDDIs was the highest in the type A ICUs. A statistically significant relationship was observed between the number of prescribed drugs and ICU length of stay (p-value < 0.001 and p = 0.009, respectively). CONCLUSION: Different patterns of intensivist staffing affect pDDIs to varying degrees. In the studied ICUs academic versus therapeutic intensivist, twice versus once-daily visit, and 8 h attendance with16 h on-call versus 24 h on-call were associated with more reductions in pDDIs. PLAIN LANGUAGE SUMMARY: The impact of different intensivist staffing patterns in ICUs on the rate of potential drug-drug interactions Drug-drug interactions (DDIs) have created alarming challenges for public health, especially in patients admitted to intensive care units (ICUs). Many studies have shown that involvement of intensivists in the ICUs improves the outcome and limits the costs. Considering the high incidence of potential DDIs (pDDIs) occurring for critically ill patients and the importance of ADRs caused by pDDIs in ICUs, the effect of the presence of an academic versus therapeutic intensivist, as well as the hour of coverage of intensivist on prevalence of pDDIs was evaluated in six adult trauma ICUs of a level one trauma center in Shiraz, Iran. We also determined the prevalence of pDDIs and their associated risk factors. To the best of our knowledge, this is the first study that has assessed the effect of various ICU physician staffing models on the incidence and pattern of pDDIs.
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spelling pubmed-77801712021-01-13 The effect of different intensivist staffing patterns on the rate of potential drug–drug interactions in adult trauma intensive care units Masjedi, Mansoor Mirjalili, Mahtabalsadat Mirzaei, Ehsan Mirzaee, Hadis Vazin, Afsaneh Ther Adv Drug Saf Original Research BACKGROUND: Drug–drug interactions (DDIs) have created alarming challenges for public health, especially in those admitted to intensive care units (ICUs). Many studies have shown that involvement of intensivists in the ICUs improves the outcome and decreases the treatment costs. The effect of academic versus non-academic (therapeutic) intensivist as well as hours of coverage and attendance of intensivist on potential DDIs (pDDIs) was evaluated in six adult trauma ICUs of a level one trauma center. METHODS: In this 6-month cross-sectional study, 200 patients were included. The DDIs were classified into five groups, including type A, B, C, D, and X. pDDIs were defined as interactions belonged to C, D and X categories. Patients in six adult ICUs with three different patterns of intensivist staffing models including type A (once-daily therapeutic intensivist visit followed by 24 h on-call), B (twice-daily academic intensivist visit, 8 h of attendance in ICU and 16 h on-call) and C (all criteria just like ICU type B, except for the presence of therapeutic instead of academic intensivist) were screened for pDDIs. RESULTS: In total, 3735 drug orders and 3869 drugs (193 different types) were screened and 1826 pDDIs were identified. Type C, D and X interactions accounted for 60.6%, 35.5%, and 3.9% of all pDDIs, respectively. The mean of pDDI per patient was significantly higher (p-value < 0.001) in the ICU type A than ICU types C and B. The frequency of pDDIs was the highest in the type A ICUs. A statistically significant relationship was observed between the number of prescribed drugs and ICU length of stay (p-value < 0.001 and p = 0.009, respectively). CONCLUSION: Different patterns of intensivist staffing affect pDDIs to varying degrees. In the studied ICUs academic versus therapeutic intensivist, twice versus once-daily visit, and 8 h attendance with16 h on-call versus 24 h on-call were associated with more reductions in pDDIs. PLAIN LANGUAGE SUMMARY: The impact of different intensivist staffing patterns in ICUs on the rate of potential drug-drug interactions Drug-drug interactions (DDIs) have created alarming challenges for public health, especially in patients admitted to intensive care units (ICUs). Many studies have shown that involvement of intensivists in the ICUs improves the outcome and limits the costs. Considering the high incidence of potential DDIs (pDDIs) occurring for critically ill patients and the importance of ADRs caused by pDDIs in ICUs, the effect of the presence of an academic versus therapeutic intensivist, as well as the hour of coverage of intensivist on prevalence of pDDIs was evaluated in six adult trauma ICUs of a level one trauma center in Shiraz, Iran. We also determined the prevalence of pDDIs and their associated risk factors. To the best of our knowledge, this is the first study that has assessed the effect of various ICU physician staffing models on the incidence and pattern of pDDIs. SAGE Publications 2020-12-28 /pmc/articles/PMC7780171/ /pubmed/33447355 http://dx.doi.org/10.1177/2042098620980640 Text en © The Author(s), 2020 https://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Research
Masjedi, Mansoor
Mirjalili, Mahtabalsadat
Mirzaei, Ehsan
Mirzaee, Hadis
Vazin, Afsaneh
The effect of different intensivist staffing patterns on the rate of potential drug–drug interactions in adult trauma intensive care units
title The effect of different intensivist staffing patterns on the rate of potential drug–drug interactions in adult trauma intensive care units
title_full The effect of different intensivist staffing patterns on the rate of potential drug–drug interactions in adult trauma intensive care units
title_fullStr The effect of different intensivist staffing patterns on the rate of potential drug–drug interactions in adult trauma intensive care units
title_full_unstemmed The effect of different intensivist staffing patterns on the rate of potential drug–drug interactions in adult trauma intensive care units
title_short The effect of different intensivist staffing patterns on the rate of potential drug–drug interactions in adult trauma intensive care units
title_sort effect of different intensivist staffing patterns on the rate of potential drug–drug interactions in adult trauma intensive care units
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780171/
https://www.ncbi.nlm.nih.gov/pubmed/33447355
http://dx.doi.org/10.1177/2042098620980640
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