BACKGROUND: Hospitals are increasingly adopting 24-hour intensivist physician staffing as a strategy to improve intensive care unit (ICU) outcomes. However, the degree to which nighttime intensivists are associated with improvements in the quality of ICU care is unknown. METHODS: We conducted a retrospective cohort study involving ICUs that participated in the Acute Physiology and Chronic Health Evaluation (APACHE) clinical information system from 2009 through 2010, linking a survey of ICU staffing practices with patient-level outcomes data from adult ICU admissions. Multivariate models were used to assess the relationship between nighttime intensivist staffing and in-hospital mortality among ICU patients, with adjustment for daytime intensivist staffing, severity of illness, and case mix. We conducted a confirmatory analysis in a second, population-based cohort of hospitals in Pennsylvania from which less detailed data were available. RESULTS: The analysis with the use of the APACHE database included 65,752 patients admitted to 49 ICUs in 25 hospitals. In ICUs with low-intensity daytime staffing, nighttime intensivist staffing was associated with a reduction in risk-adjusted in-hospital mortality (adjusted odds ratio for death, 0.62; P=0.04). Among ICUs with high-intensity daytime staffing, nighttime intensivist staffing conferred no benefit with respect to risk-adjusted in-hospital mortality (odds ratio, 1.08; P=0.78). In the verification cohort, there was a similar relationship among daytime staffing, nighttime staffing, and in-hospital mortality. The interaction between nighttime staffing and daytime staffing was not significant (P=0.18), yet the direction of the findings were similar to those in the APACHE cohort. CONCLUSIONS: The addition of nighttime intensivist staffing to a low-intensity daytime staffing model was associated with reduced mortality. However, a reduction in mortality was not seen in ICUs with high-intensity daytime staffing. (Funded by the National Heart, Lung, and Blood Institute.).
BACKGROUND: Hospitals are increasingly adopting 24-hour intensivist physician staffing as a strategy to improve intensive care unit (ICU) outcomes. However, the degree to which nighttime intensivists are associated with improvements in the quality of ICU care is unknown. METHODS: We conducted a retrospective cohort study involving ICUs that participated in the Acute Physiology and Chronic Health Evaluation (APACHE) clinical information system from 2009 through 2010, linking a survey of ICU staffing practices with patient-level outcomes data from adult ICU admissions. Multivariate models were used to assess the relationship between nighttime intensivist staffing and in-hospital mortality among ICU patients, with adjustment for daytime intensivist staffing, severity of illness, and case mix. We conducted a confirmatory analysis in a second, population-based cohort of hospitals in Pennsylvania from which less detailed data were available. RESULTS: The analysis with the use of the APACHE database included 65,752 patients admitted to 49 ICUs in 25 hospitals. In ICUs with low-intensity daytime staffing, nighttime intensivist staffing was associated with a reduction in risk-adjusted in-hospital mortality (adjusted odds ratio for death, 0.62; P=0.04). Among ICUs with high-intensity daytime staffing, nighttime intensivist staffing conferred no benefit with respect to risk-adjusted in-hospital mortality (odds ratio, 1.08; P=0.78). In the verification cohort, there was a similar relationship among daytime staffing, nighttime staffing, and in-hospital mortality. The interaction between nighttime staffing and daytime staffing was not significant (P=0.18), yet the direction of the findings were similar to those in the APACHE cohort. CONCLUSIONS: The addition of nighttime intensivist staffing to a low-intensity daytime staffing model was associated with reduced mortality. However, a reduction in mortality was not seen in ICUs with high-intensity daytime staffing. (Funded by the National Heart, Lung, and Blood Institute.).
Authors: Derek C Angus; Andrew F Shorr; Alan White; Tony T Dremsizov; Robert J Schmitz; Mark A Kelley Journal: Crit Care Med Date: 2006-04 Impact factor: 7.598
Authors: Anand Kumar; Daniel Roberts; Kenneth E Wood; Bruce Light; Joseph E Parrillo; Satendra Sharma; Robert Suppes; Daniel Feinstein; Sergio Zanotti; Leo Taiberg; David Gurka; Aseem Kumar; Mary Cheang Journal: Crit Care Med Date: 2006-06 Impact factor: 7.598
Authors: Peter J Pronovost; Derek C Angus; Todd Dorman; Karen A Robinson; Tony T Dremsizov; Tammy L Young Journal: JAMA Date: 2002-11-06 Impact factor: 56.272
Authors: Jeremy M Kahn; Christopher H Goss; Patrick J Heagerty; Andrew A Kramer; Chelsea R O'Brien; Gordon D Rubenfeld Journal: N Engl J Med Date: 2006-07-06 Impact factor: 91.245
Authors: Ognjen Gajic; Bekele Afessa; Andrew C Hanson; Tami Krpata; Murat Yilmaz; Shehab F Mohamed; Jeffrey T Rabatin; Laura K Evenson; Timothy R Aksamit; Steve G Peters; Rolf D Hubmayr; Mark E Wylam Journal: Crit Care Med Date: 2008-01 Impact factor: 7.598
Authors: Jason P Lott; Theodore J Iwashyna; Jason D Christie; David A Asch; Andrew A Kramer; Jeremy M Kahn Journal: Am J Respir Crit Care Med Date: 2009-02-06 Impact factor: 21.405
Authors: Marilyn T Haupt; Carolyn E Bekes; Richard J Brilli; Linda C Carl; Anthony W Gray; Michael S Jastremski; Douglas F Naylor; Maria Rudis PharmD; Antoinette Spevetz Md; Suzanne K Wedel; Mathilda Horst Md Journal: Crit Care Med Date: 2003-11 Impact factor: 7.598
Authors: Mihaela S Stefan; Brian H Nathanson; Thomas L Higgins; Jay S Steingrub; Tara Lagu; Michael B Rothberg; Peter K Lindenauer Journal: Crit Care Med Date: 2015-07 Impact factor: 7.598