Transition to an In-House Night Float System for Critical Care Fellows: Resident Experience, Morbidity, and Mortality...

Area of Science:

• Critical Care Medicine
• Medical Education
• Healthcare Management

Background:

• In-house night call systems in ICUs aim to improve patient care and resident supervision.
• Previous studies on night float (NF) systems show benefits in intervention times but inconsistent patient outcome improvements.

Purpose of the Study:

• To evaluate the impact of an in-house overnight critical care fellow on resident experience.
• To assess the effect of this staffing model on patient morbidity and mortality.

Main Methods:

• An in-house overnight critical care fellow shift was implemented in the MICU.
• Anonymous surveys assessed resident physicians' experience before and after the intervention.
• A retrospective chart review compared patient outcomes (300 admissions) pre- and post-intervention.

Main Results:

• Resident surveys showed significant improvements in support, procedural comfort, and treatment input, with reduced feelings of being overwhelmed.
• Patient outcomes, including ICU/hospital length of stay and mechanical ventilation use, remained unchanged.
• No significant difference in mortality was observed, though the study was underpowered for this outcome.

Conclusions:

• The addition of an in-house overnight critical care fellow positively impacted resident experience in the MICU.
• This staffing model did not worsen patient morbidity or mortality outcomes.
• The in-house night float coverage model is preferred by clinicians and led to an increase in overnight procedures.