Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2012 May 31;366(22):2093-101.
doi: 10.1056/NEJMsa1201918. Epub 2012 May 21.

Nighttime intensivist staffing and mortality among critically ill patients

David J Wallace  1 , Derek C Angus, Amber E Barnato, Andrew A Kramer, Jeremy M Kahn
Affiliations

Nighttime intensivist staffing and mortality among critically ill patients

David J Wallace et al. N Engl J Med. .

Erratum in

  • N Engl J Med. 2012 Aug 30;367(9):881

Abstract

Background: Hospitals are increasingly adopting 24-hour intensivist physician staffing as a strategy to improve intensive care unit (ICU) outcomes. However, the degree to which nighttime intensivists are associated with improvements in the quality of ICU care is unknown.

Methods: We conducted a retrospective cohort study involving ICUs that participated in the Acute Physiology and Chronic Health Evaluation (APACHE) clinical information system from 2009 through 2010, linking a survey of ICU staffing practices with patient-level outcomes data from adult ICU admissions. Multivariate models were used to assess the relationship between nighttime intensivist staffing and in-hospital mortality among ICU patients, with adjustment for daytime intensivist staffing, severity of illness, and case mix. We conducted a confirmatory analysis in a second, population-based cohort of hospitals in Pennsylvania from which less detailed data were available.

Results: The analysis with the use of the APACHE database included 65,752 patients admitted to 49 ICUs in 25 hospitals. In ICUs with low-intensity daytime staffing, nighttime intensivist staffing was associated with a reduction in risk-adjusted in-hospital mortality (adjusted odds ratio for death, 0.62; P=0.04). Among ICUs with high-intensity daytime staffing, nighttime intensivist staffing conferred no benefit with respect to risk-adjusted in-hospital mortality (odds ratio, 1.08; P=0.78). In the verification cohort, there was a similar relationship among daytime staffing, nighttime staffing, and in-hospital mortality. The interaction between nighttime staffing and daytime staffing was not significant (P=0.18), yet the direction of the findings were similar to those in the APACHE cohort.

Conclusions: The addition of nighttime intensivist staffing to a low-intensity daytime staffing model was associated with reduced mortality. However, a reduction in mortality was not seen in ICUs with high-intensity daytime staffing. (Funded by the National Heart, Lung, and Blood Institute.).

PubMed Disclaimer

Figures

Figure 1
Figure 1
Numbers of Patients, Intensive Care Units (ICUs), and Hospitals in the Study.
See this image and copyright information in PMC

Comment in

  • Intensive enough?
    Campbell V. Campbell V. N Engl J Med. 2012 May 31;366(22):2124-5. doi: 10.1056/NEJMe1203772. Epub 2012 May 21. N Engl J Med. 2012. PMID: 22612640 No abstract available.
  • Nighttime intensivist staffing.
    Raikhelkar J, Scurlock C, Kopec I. Raikhelkar J, et al. N Engl J Med. 2012 Sep 6;367(10):971; author reply 972. doi: 10.1056/NEJMc1207796. N Engl J Med. 2012. PMID: 22931273 No abstract available.
  • Nighttime intensivist staffing.
    Chao CM, Lai CC. Chao CM, et al. N Engl J Med. 2012 Sep 6;367(10):971; author reply 972. doi: 10.1056/NEJMc1207796. N Engl J Med. 2012. PMID: 22931274 No abstract available.
  • Nighttime intensivist staffing.
    Sareli A. Sareli A. N Engl J Med. 2012 Sep 6;367(10):971-2; author reply 972. doi: 10.1056/NEJMc1207796. N Engl J Med. 2012. PMID: 22931275 No abstract available.

References

    1. Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA. 2002;288:2151–62. - PubMed
    1. Haupt MT, Bekes CE, Brilli RJ, et al. Guidelines on critical care services and personnel: recommendations based on a system of categorization of three levels of care. Crit Care Med. 2003;31:2677–83. - PubMed
    1. Burnham EL, Moss M, Geraci MW. The case for 24/7 in-house intensivist coverage. Am J Respir Crit Care Med. 2010;181:1159–60. - PubMed
    1. Cartin-Ceba R, Bajwa EK. 24-Hour on-site intensivist in the intensive care unit: yes. Am J Respir Crit Care Med. 2010;181:1279–80. - PubMed
    1. Jones SF, Gaggar A. Is there a doctor in the house? The downside of 24/7 attending coverage in academic intensive care units. Am J Respir Crit Care Med. 2010;181:1280–1. - PubMed

Publication types