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Are Intensivists Needed at Night in the ICU?

Summary and Comment |
July 23, 2013

Are Intensivists Needed at Night in the ICU?

  1. Patricia Kritek, MD

Nighttime intensivist staffing did not improve patient outcomes in an academic intensive care unit.

  1. Patricia Kritek, MD

During the past decade, nighttime intensivist staffing has been implemented in a growing number of intensive care units (ICUs). To assess the effects of nighttime intensivist coverage on patient outcomes, investigators at the University of Pennsylvania conducted a 1-year randomized study in which intensivist coverage between 7:00 PM and 7:00 AM was provided in 1-week blocks either by dedicated nighttime intensivists (intervention periods) or through phone or beeper coverage by daytime intensivists and fellows (control periods).

Analysis involved 1598 patients, 61% of whom were admitted to the ICU at night. ICU length of stay, hospital length of stay, ICU and hospital mortality, and readmission to the ICU did not differ between patients admitted on control days versus intervention days. Subgroup analyses of the sickest patients and patients who were admitted at night yielded the same results. On surveys, most residents indicated that they felt more supported and had better educational experiences when a nighttime intensivist was present.

Comment

Care should be taken in interpreting these results. Although these findings make it difficult to argue that nocturnal intensivist coverage improves patient outcomes (in academic ICUs), they do not necessarily extend to community hospital ICUs or those without daytime intensivist presence. Moreover, whether the presence of nocturnal intensivists affects patient experience, nursing satisfaction, or physician burnout remains unclear.

  • Disclosures for Patricia Kritek, MD at time of publication Editorial boards ACP Medicine; New England Journal of Medicine

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