Nighttime Cross-Coverage Is Associated with Decreased Intensive Care Unit Mortality. A Single-Center Study

Amaral, Andre Carlos Kajdacsy-Balla; Barros, Bernardo S.; Barros, Camilla C. P. P.; Innes, Cameron; Pinto, Ruxandra; Rubenfeld, Gordon D.

doi:10.1164/rccm.201312-2181oc

Cited by 32 publications

(37 citation statements)

References 30 publications

(31 reference statements)

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“…Two large multicentre observational studies involving 49 and 143 ICUs have previously demonstrated no benefits of night-time intensivists, regardless of daytime staffing model [54,55]. Others studies showed however an improved ICU mortality with night-time physician staffing [38,56]. …”

Section: Discussionmentioning

confidence: 99%

Mortality Associated with Night and Weekend Admissions to ICU with On-Site Intensivist Coverage: Results of a Nine-Year Cohort Study (2006-2014)

Brunot¹,

Landreau²,

Corne³

et al. 2016

PLoS ONE

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BackgroundThe association between mortality and time of admission to ICU has been extensively studied but remains controversial. We revaluate the impact of time of admission on ICU mortality by retrospectively investigating a recent (2006–2014) and large ICU cohort with on-site intensivist coverage.Patients and MethodsAll adults (≥ 18 years) admitted to a tertiary care medical ICU were included in the study. Patients' characteristics, medical management, and mortality were prospectively collected. Patients were classified according to their admission time: week working days on- and off-hours, and weekends. ICU mortality was the primary outcome and adjusted Hazard-ratios (HR) of death were analysed by multivariate Cox model.Results2,428 patients were included: age 62±18 years; male: 1,515 (62%); and median SAPSII score: 38 (27–52). Overall ICU mortality rate was 13.7%. Admissions to ICU occurred during open-hours in 680 cases (28%), during night-time working days in 1,099 cases (45%) and during weekends in 649 cases (27%). Baseline characteristics of patients were similar between groups except that patients admitted during the second part of night (00:00 to 07:59) have a significantly higher SAPS II score than others. ICU mortality was comparable between patients admitted during different time periods but was significantly higher for those admitted during the second part of the night. Multivariate analysis showed however that admission during weeknights and weekends was not associated with an increased ICU mortality as compared with open-hours admissions.ConclusionTime of admission, especially weeknight and weekend (off-hour admissions), did not influence the prognosis of ICU patients. The higher illness severity of patients admitted during the second part of the night (00:00–07:59) may explain the observed increased mortality.

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Section: Discussionmentioning

confidence: 99%

Mortality Associated with Night and Weekend Admissions to ICU with On-Site Intensivist Coverage: Results of a Nine-Year Cohort Study (2006-2014)

Brunot¹,

Landreau²,

Corne³

et al. 2016

PLoS ONE

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“…A potential mechanism for the latter effect is communication of an “authoritative” summary of each patient’s clinical status that is insufficiently challenged by the on-call team when patients deteriorate. This hypothesis is supported by a single-center study that found more nighttime decisions and lower ICU mortality in patients exposed to on-call cross-covering fellows [19]. These findings contradict the dominant hypothesis that cross-coverage is associated with worse outcomes, and suggest that a “second look” by cross-covering fellows may mitigate cognitive errors.…”

Section: Discussionmentioning

confidence: 90%

Comparing mortality among adult, general intensive care units in England with varying intensivist cover patterns: a retrospective cohort study

et al. 2014

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IntroductionResearch has demonstrated that intensivist-led care of the critically ill is associated with reduced intensive care unit (ICU) and hospital mortality. The objective of this study was to evaluate whether a relation exists between intensivist cover pattern (for example, number of days of continuous cover) and patient outcomes among adult general ICUs in England.MethodsWe conducted a retrospective cohort study by using data from a pooled case mix and outcome database of adult general critical care units participating in the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme. Consecutive admissions to participating units for the years 2010 to 2011 were linked to a survey of intensivist cover practices. Our primary outcome of interest was mortality at ultimate discharge from acute-care hospital.ResultsThe analysis included 80,122 patients admitted to 130 ICUs in 128 hospitals. Multivariable logistic regression analysis was used to assess the relation between intensivist cover patterns (days of continuous cover, grade of physician staffing at nighttime, and frequency of daily handovers) and acute hospital mortality, adjusting for patient case mix. No relation was seen between days of continuous cover by a single intensivist or grade of physician staffing at nighttime and acute hospital mortality. Acute hospital mortality and ICU length of stay were not associated with intensivist characteristics, intensivist full-time equivalents per bed, or years of clinical experience. Intensivist participation in handover was associated with increased mortality (odds ratio, 1.27; 95% confidence interval, 1.04 to 1.55); however, only nine units reported no intensivist participation.ConclusionsWe found no relation between days of continuous cover by a single intensivist or grade of physician staffing at nighttime and patient outcomes in adult, general ICUs in England. Intensivist participation in handover was associated with increased mortality; further research to confirm or refute this finding is required.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0491-3) contains supplementary material, which is available to authorized users.

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“…(7) These can be errors of omission or corruption of information, (12) impact clinical decision making (13) and discharge planning. (7) …”

Section: Challenges To Handovers In Critically Ill Patientsmentioning

confidence: 99%

“…These data suggest that the incoming clinician's different perspective may have helped them identify the problems that were overlooked by the daytime clinicians. (13) Once we acknowledge this crucial function of re-thinking about the patient during handovers, it is clear that we need to focus not only on what information is communicated but also on the interactions between clinicians during a handover.…”

Section: Challenges To Handovers In Critically Ill Patientsmentioning

confidence: 99%

What every intensivist should know about handovers in the intensive care unit

d’Empaire

Amaral

2017

Revista Brasileira De Terapia Intensiva

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Nighttime Cross-Coverage Is Associated with Decreased Intensive Care Unit Mortality. A Single-Center Study

Cited by 32 publications

References 30 publications

Mortality Associated with Night and Weekend Admissions to ICU with On-Site Intensivist Coverage: Results of a Nine-Year Cohort Study (2006-2014)

Mortality Associated with Night and Weekend Admissions to ICU with On-Site Intensivist Coverage: Results of a Nine-Year Cohort Study (2006-2014)

Comparing mortality among adult, general intensive care units in England with varying intensivist cover patterns: a retrospective cohort study

What every intensivist should know about handovers in the intensive care unit

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