Impact of 24/7 In-Hospital Intensivist Coverage on Outcomes in Pediatric Intensive Care. A Multicenter Study

Area of Science:

• Pediatric Critical Care Medicine
• Healthcare Quality Improvement
• Intensivist Staffing Models

Background:

• Continuous in-house attending physician coverage (24/7) in pediatric intensive care units (PICUs) is hypothesized to improve outcomes for critically ill children.
• Previous research suggests a potential benefit, but robust evidence is needed to confirm this association.

Purpose of the Study:

• To investigate the association between 24/7 in-house attending critical care physician coverage and patient outcomes in a large cohort of critically ill children.
• To determine if continuous intensivist presence impacts mortality, cardiac arrest rates, and length of stay in the PICU.

Main Methods:

• A retrospective analysis of the Virtual Pediatric Systems Database (2009-2014) included over 455,000 patients from 125 hospitals.
• Generalized linear mixed effects multivariable regression models were used for the main analysis.
• Multiple sensitivity analyses were conducted to ensure the robustness of the findings.

Main Results:

• Hospitals with 24/7 intensivist coverage showed significantly lower intensive care unit (ICU) mortality (OR, 0.52; P=0.002).
• 24/7 coverage was associated with reduced cardiac arrest incidence (OR, 0.73; P=0.04) and lower post-arrest mortality (OR, 0.56; P=0.02).
• Patients in 24/7 ICUs experienced shorter ICU stays and reduced mechanical ventilation duration.

Conclusions:

• This large observational study demonstrates that 24/7 intensivist presence in PICUs is associated with improved survival and reduced adverse events in critically ill children.
• The findings suggest that continuous intensivist staffing is a valuable model for enhancing care quality and patient outcomes.
• While generally robust, some sensitivity analyses indicated minor ambiguities, warranting further investigation.