Night Staffing With Critical Care Docs May Lower ICU Death Rates
However, study didn't find similar benefit for all hospitals
MONDAY, May 21, 2012 (HealthDay News) -- Having so-called intensivist physicians on staff in intensive care units during the night can reduce death rates in ICUs that do not have similar coverage during the day, according to a large new study.
An intensivist is a doctor who specializes in the care of critically ill patients. ICUs that have intensivists who manage or co-manage patients during the day are referred to as high-intensity, while those with optional or no intensivist involvement are low-intensity.
Previous research showing that high-intensity ICUs have lower death rates prompted many hospitals to increase the intensivist presence in their ICUs, including having them there around the clock, according to a news release from the American Thoracic Society.
The impact of having 24-hour intensivist staffing in ICUs, however, has not been well studied, said Dr. Jeremy Kahn, an associate professor of critical care medicine and health policy and management at the University of Pittsburgh.
Kahn and his colleagues analyzed data from nearly 66,000 patients admitted to 49 ICUs in 25 U.S. hospitals in 2009 and 2010. Their findings were scheduled for presentation Monday at the society's international conference in San Francisco and also appear in the New England Journal of Medicine.
"Our study indicates that 24-hour intensivists are likely to improve patient outcomes only in some circumstances," Kahn said in the news release. "ICUs with low-intensity daytime staffing -- the most common staffing model in the United States -- have better outcomes when intensivists are also present at night. Nationally, two-thirds of ICUs have no intensivists at night, so expanding the role of intensivists in these ICUs could translate into improved health care."
"Equally important, we found that ICUs with high-intensity daytime staffing did not share the same benefit from nighttime intensivists," Kahn added. "These ICUs, which frequently already have residents and other trainees in the ICU at night, saw no mortality reduction from the addition of nighttime intensivists. This shows that the movement to expand intensivist presence in these hospitals may be premature, especially since intensivists are in relatively short supply."
The Society of Critical Care Medicine has more about intensivists and other health providers in the intensive care unit.