A Randomized Trial of Nighttime Physician Staffing in an Intensive Care Unit

• Published in: The New England journal of medicine Vol. 368; no. 23; pp. 2201 - 2209
• Main Authors: Kerlin, Meeta Prasad, Small, Dylan S, Cooney, Elizabeth, Fuchs, Barry D, Bellini, Lisa M, Mikkelsen, Mark E, Schweickert, William D, Bakhru, Rita N, Gabler, Nicole B, Harhay, Michael O, Hansen-Flaschen, John, Halpern, Scott D
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 06.06.2013
• Subjects: Aged; Biological and medical sciences; Data processing; Evidence-based medicine; Female; General aspects; Health participants; Hospital Mortality; Hospitalists; Hospitalization; Hospitals; Hospitals, University; Humans; Intensive care; Intensive care units; Intensive Care Units - manpower; Kaplan-Meier Estimate; Length of Stay; Male; Medical sciences; Middle Aged; Mortality; Nighttime; Pennsylvania; Personnel Staffing and Scheduling; Physicians; Public health. Hygiene; Public health. Hygiene-occupational medicine; Sensitivity analysis; Pennsylvania; United States > US; Medicine; Randomization; Health staff; Number of employees; Health care staff; Physician; Clinical trial; Staff recruitment; Intensive care unit
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa1302854

In this single-center, controlled trial at a U.S. academic medical center, investigators found that having in-house intensivists available at night did not have a significant effect on the length of stay in the ICU. Most studies suggest that intensivist physicians improve patient outcomes in intensive care units (ICUs). 1 – 3 It is thus tempting to conclude that a “dose–response effect” might exist, such that greater exposure to intensivists would be associated with even better outcomes. 4 Indeed, some authors argue that 24-hour presence of seasoned intensivists at the bedside of patients would improve diagnostic and therapeutic efficiency, particularly for high-risk patients. 5 – 7 As a result, many ICUs, including one third of academic ICUs in the United States 8 and nearly three quarters of ICUs in Europe, 9 , 10 use in-hospital intensivist staffing at night. Before-and-after studies of nighttime . . .