The Impact of Implementing an Intensivist Model With Nighttime In-Hospital Nocturnist and Effect on ICU Outcomes

Area of Science:

• Critical Care Medicine
• Hospital Administration
• Healthcare Operations

Background:

• Intensivist staffing models vary in sustainability and outcomes.
• Previous models have not always been sustained long-term.
• The effectiveness of high-intensity intensivist coverage with nocturnist support requires examination.

Purpose of the Study:

• To evaluate the impact of a high-intensity intensivist coverage model.
• To assess the effect of nighttime in-house nocturnist staffing on ICU outcomes.
• To determine the long-term sustainability of this staffing model.

Main Methods:

• Comparative analysis of historical control data (2007-2011) and post-implementation data (2011-2015).
• Utilized the Acute Physiological and Chronic Health Evaluation (APACHE) system for data collection and outcome prediction.
• Implemented a model with mandatory in-house daytime intensivists and nighttime nocturnists, with remote intensivist support.

Main Results:

• Improved ICU patient throughput and stable case mix.
• Decreased intensive care unit length of stay, with observed-to-predicted stay consistently lower.
• Improved intensive care unit mortality (standardized mortality ratio of 0.84) and resident satisfaction.

Conclusions:

• A high-intensity intensivist service with nighttime nocturnist staffing is feasible in large teaching hospitals.
• This model leads to sustained improvements in ICU outcomes, including reduced length of stay.
• The implemented staffing model demonstrates long-term viability and positive effects on patient care.