Nighttime physician staffing improves patient outcomes: no

Kerlin, Meeta Prasad; Halpern, Scott D.

doi:10.1007/s00134-016-4367-7

Cited by 8 publications

(3 citation statements)

References 13 publications

(16 reference statements)

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“…20 21 22 Studies in adult ICUs have also shown varying impacts of 24-hour in-house intensivist coverage; some reported a reduction in mortality, while others found no impact on mortality. 9 10 11 12 20 23 Consequently, we aimed to assess the association of 24-hour in-house NN coverage with death and/or major morbidity and care practices among extremely preterm infants <29 weeks' GA born in hospitals with a level-3 NICU.…”

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confidence: 99%

Association of 24-Hour In-house Neonatologist Coverage with Outcomes of Extremely Preterm Infants

et al. 2022

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Objective To assess if 24-hour (h) in-house neonatologist (NN) coverage is associated with delivery room resuscitation/stabilization and outcomes among inborn infants <29 weeks’ GA. Study design Survey-linked cohort study of 2476 inborn infants 23-28 weeks’ gestation, admitted 2014-2015 to Canadian Neonatal Network Level 3 NICUs with a maternity unit. Exposures were classified using survey responses based on the most senior provider offering 24-h in-house coverage: NN, fellow, and no NN/fellow. Primary outcome was death and/or major morbidity (bronchopulmonary dysplasia, severe neurological injury, late-onset sepsis, necrotizing enterocolitis, retinopathy of prematurity). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and adjust for confounders. Results Among the 28 participating NICUs, most senior providers ensuring 24-h in-house coverage were NN (32%, 9/28), fellows (39%, 11/28), and no NN/fellow (29%, 8/28). No NN/fellow coverage and 24-h fellow coverage were associated with higher odds of infants receiving delivery room (DR) chest compressions/epinephrine compared to 24-h NN coverage (adjusted odds ratio [AOR] 4.72, 95% CI 2.12-10.6 and AOR 3.33, 95% CI 1.44-7.70, respectively). Rates of mortality/major morbidity did not differ significantly among the three groups: NN, 63% (249/395 infants); fellow, 64% (1092/1700 infants); no NN/fellow, 70% (266/381 infants). Conclusion 24-h in-house NN coverage was associated with lower rates of DR chest compressions/epinephrine. There was no difference in neonatal outcomes based on type of coverage; however, further studies are needed as ecological fallacy cannot be ruled out.

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confidence: 99%

Association of 24-Hour In-house Neonatologist Coverage with Outcomes of Extremely Preterm Infants

et al. 2022

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“…The best strategy to care for critically ill patients overnight inspires great debate. 1,2 Therefore, Huard and colleagues 3 should be commended for their work assessing the association of 24-hour intensivist coverage in a cardiac surgery intensive care unit (ICU) with outcomes. They compared 2 eras in their cardiac surgery ICU.…”

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confidence: 99%

Commentary: Nighttime stars: Intensivist coverage and cardiac surgical outcomes

Metkus

Whitman

2020

The Journal of Thoracic and Cardiovascular Surgery

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“…The pro debaters suggest that, from both personal experience and the existing literature, there is ample evidence that dedicated nighttime ICU senior physician staffing improves outcomes for patients and for staff and that the difficulty lies only in teasing out from the existing evidence when, where and how outcomes are improved-given the important role played by context. The con debaters [5] suggest that while the premise of dedicated nighttime ICU senior physician staffing appears intuitively one that would seem to improve patient outcomes, the evidence does not support this. However, they accept a need to consider not only the patient outcomes studied to date (predominantly mortality and length of stay) but also other outcomes for patients (e.g.…”

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confidence: 99%

Nighttime physician staffing improves patient outcomes: we are not sure

2016

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The financial cost to implement dedicated nighttime senior physician staffing in intensive care units (ICUs) would not be inconsiderable to any healthcare system. Therefore, prior to embarking on such a financial outlay, there would need to be substantive evidence around two major areas: (1) evidence that there is a nighttime "problem" and (2) evidence that dedicated nighttime ICU senior physician staffing fixed/mitigated the nighttime "problem" and delivered benefits, including economic benefits, to offset the financial outlay.With respect to (1), while there is evidence that discharging patients from ICU at night can be harmful in some healthcare settings (with night used as a proxy either for premature ICU discharge and/or a period when staffing on the ward/floor is lower) [1], evidence of "harms" to patients who are admitted at night is conflicting [2] and for those who remain in the ICU overnight appears limited. Though not within the scope of this debate on patient outcomes, with respect to "harms" to family members, the evidence seems non-existent and with respect to "harms" to staff, there is some evidence that ICU physicians, working within a daytime-only model, may suffer cognitive fatigue and sleep deprivation and that this may impair performance. With regard to (2), while there is evidence that exposure to ICU physician staffing per se may improve patient outcomes (e.g. those treated in ICU physician-led or "closed" units) [3], the evidence that dedicated nighttime ICU senior physician staffing affords additional benefits to patients appears conflicting and limited.The pro debaters [4] consider the question of dedicated nighttime ICU senior physician staffing broadlyincluding not only the impact on patient outcomes (the scope of this debate) but also on daytime ICU physicians' workload and the cumulative role of fatigue and sleep deprivation on performance and burnout. The pro debaters suggest that, from both personal experience and the existing literature, there is ample evidence that dedicated nighttime ICU senior physician staffing improves outcomes for patients and for staff and that the difficulty lies only in teasing out from the existing evidence when, where and how outcomes are improved-given the important role played by context. The con debaters [5] suggest that while the premise of dedicated nighttime ICU senior physician staffing appears intuitively one that would seem to improve patient outcomes, the evidence does not support this. However, they accept a need to consider not only the patient outcomes studied to date (predominantly mortality and length of stay) but also other outcomes for patients (e.g. quality of care including end-of-life care, quality of life, etc.), for family members/caregivers (e.g. family satisfaction) and for payers (e.g. staff satisfaction, cost savings) and agree that this evidence is far from substantive. The con debaters conclude that, given the absence of direct evidence of benefit of dedicated nighttime ICU senior physician staffing on the patient outcomes th...

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Nighttime physician staffing improves patient outcomes: no

Cited by 8 publications

References 13 publications

Association of 24-Hour In-house Neonatologist Coverage with Outcomes of Extremely Preterm Infants

Association of 24-Hour In-house Neonatologist Coverage with Outcomes of Extremely Preterm Infants

Commentary: Nighttime stars: Intensivist coverage and cardiac surgical outcomes

Nighttime physician staffing improves patient outcomes: we are not sure

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