Should Medical ICUs Have Nighttime Attending Staff?

Summary and Comment |
June 20, 2011

Should Medical ICUs Have Nighttime Attending Staff?

  1. Arun V. Mohan, MD, MBA, and
  2. Daniel D. Dressler, MD, MSc, SFHM

A 24/7 intensivist staffing model shortened length of stay and lowered costs.

  1. Arun V. Mohan, MD, MBA, and
  2. Daniel D. Dressler, MD, MSc, SFHM

Staffing models in medical intensive care units (ICUs) vary widely, and published evidence is unclear about whether 24/7 in-house intensivist models lead to lower patient mortality and shorter lengths of stay (LOS) than do daytime-only models. In addition, economic implications of a 24/7 intensivist model have not been studied.

Researchers conducted a retrospective analysis of resource use and associated costs during 1 year before and 1 year after implementation of nighttime attending intensivist staffing (in addition to daytime intensivist coverage) at a 24-bed medical ICU affiliated with an academic medical center in Minnesota. The only intervention cost was compensation for 2.1 full-time–equivalent intensivists to cover nights. The investigators controlled for potential confounders and stratified the patient data (≈4000 admissions) by severity of illness (Acute Physiology and Chronic Health Evaluation [APACHE] III quartiles) and time of admission (day or night).

ICU LOS fell in the postintervention period relative to the preintervention period (mean LOS, 2.6 vs. 3.0 days) as a result of shorter LOS among patients admitted at night (mean, 2.3 vs. 2.8 days). Total costs for the sickest patients admitted at night were 61% lower in the postintervention period (>US$10,000 in savings per patient).

Comment

The cost savings demonstrated in this single-center study might not be realized in all settings. ICUs that are small, provide care for lower-acuity patients, or have low demand for services might not be able to reduce overhead further, shorten length of stay, or fill open beds. However, this study suggests that 24/7 intensivist staffing lowers costs of care for very ill ICU patients and could offer high value for large healthcare organizations.

Dr. Mohan is an Instructor of Medicine at Emory University School of Medicine in Atlanta, Georgia.

Citation(s):

Reader Comments (1)

Rachel Baer

The point of view of an intensivist is very favorable to a night staff . But it cannot work at the same level as the dayly staff because the entire hospital is working without night staffs in all services. But ultimatly , even a modest favorable influence in health reflected in shorter LOS will be also economically convenient. (taking in account that in my country the physicians earn a very low salary. )

Competing interests: None declared

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