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Collecting Sleep, Circadian, Fatigue, and Performance Data in Complex Operational Environments
Published on: August 8, 2019
[Is nighttime intensivist staffing beneficial?]
P Pickkers1, J G van der Hoeven
1UMC St Radboud, afd. Intensive Care, Nijmegen.
Nederlands Tijdschrift Voor Geneeskunde
|August 16, 2013
Summary
Intensivist staffing in intensive care units (ICUs) overnight did not improve patient outcomes. A randomized trial found no significant difference in mortality or length of stay when intensivists were present versus available by phone.
Area of Science:
- Critical Care Medicine
- Hospital Management
- Patient Outcomes
Background:
- Intensive care units (ICUs) managed by intensivists show improved patient prognosis.
- Retrospective studies suggest higher mortality for critically ill patients admitted during off-hours.
- This off-hours mortality difference may be linked to intensivist availability, but patient case mix also plays a role.
Purpose of the Study:
- To prospectively evaluate the effectiveness of nighttime intensivist presence in the ICU.
- To determine if 24/7 intensivist staffing impacts patient mortality and length of stay.
Main Methods:
- A prospective randomized controlled trial was conducted.
- Intensivist staffing alternated weekly: in-hospital presence versus telephone consultation.
- Outcomes measured included ICU length of stay, mortality, and secondary endpoints.
Main Results:
- No significant difference was found in ICU length of stay between the two staffing models.
- Nighttime intensivist presence did not reduce overall mortality rates.
- No significant impact was observed on any of the secondary outcome measures.
Conclusions:
- Despite the intuitive benefit of nighttime intensivist staffing, this study found no demonstrable improvement in patient outcomes.
- The practice of 24/7 intensivist staffing in ICUs cannot be recommended based solely on current experimental evidence.
- Further research may be needed to clarify the role of intensivist staffing models in critical care.
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