The benefits of 24/7 in-house intensivist coverage for prolonged-stay cardiac surgery patients

Abstract

For patients requiring a prolonged ICU stay, our model of 24/7 in-house intensivist coverage was not associated with changes in ICU LOS, nor ICU and 30-day mortality. However a reduction in blood product use, ICU complications, and total hospital LOS was observed.

Is routine extubation overnight safe in cardiac surgery patients?

“…14 Additionally, 24-hour intensivist coverage in cardiothoracic surgery ICUs has been demonstrated to be associated with improved outcomes, indicating that continuation of daytime practices to the night may be beneficial in these patients. 15,16 The outcomes of overnight extubation are especially relevant in the cardiac surgery population, where the risks of extubating patients overnight compared to the well-studied benefits of early extubation carry important implications for intensivist staffing, quality metric reporting, and reduction in healthcare associated costs. However, this has not been well studied in a uniquely cardiac surgery population.…”

Commentary: Time to standardize physician expertise and coverage in cardiac intensive care units?

“…The findings from this study are supported by others who advocate for the benefits of an intensivist-driven, high-intensity staffing model in patients undergoing cardiac surgery. 3,4 Although the results of this study and others are encouraging, one should note that many of the primary outcomes highlighted in these studies, such as ICU length of stay, hospital length of stay, and blood product use may be considered as discretionary and often reflect subjective rather than objective clinical decision making. As such, these results should be interpreted with caution because they may have been influenced by factors other than ICU staffing models, including individual physician practice patterns, overall institutional drivers, or changing culture within ICUs.…”

Association of earlier extubation and postoperative delirium after coronary artery bypass grafting

“…This single-center, historical cohort study was conducted at a universityaffiliated Canadian tertiary care hospital where all patients were managed postoperatively in an ICU with 24-hour physician coverage. 19,20 The study protocol was reviewed by our institutional review board and approved before the commencement of the study. Data for consecutive patients were reviewed from a prospectively maintained database between April 1, 2010, and December 31, 2015.…”