Manning ICU with 24-hour specialist staff does not improve long-term survival

By Sarah Guy, MedWire Reporter

Having round-the-clock rather than on-demand presence of an intensivist does not increase intensive care unit (ICU) patients' long-term survival rates, report US researchers.

Their study showed that the staffing change did significantly improve the physical component scores of a quality of life (QoL) measurement however, writes the team in the Journal of Critical Care.

While previous studies have focused on in-hospital mortality as an assessment of critical care, Ognjen Gajic (Mayo Clinic, Rochester, Minnesota) and colleagues suggest that long-term survival and QoL outcomes may be a better marker in view of the increasing numbers of patients who survive critical illness.

"Assessment of these outcome measures could help families and health care providers in setting goals of ICU care and potentially help in ICU decision making," they suggest.

However, after introducing an additional night-shift critical care specialist staff member to attend to all ICU patient needs between 7pm and 7am in their 24-bed ICU unit, Gajic and colleagues found no difference in patients' survival rates 6 months after ICU discharge, compared with before the staffing change - when specialists attended the ICU on an as-needed basis.

One possible explanation for their result could be that "the intervention itself presented only a minor incremental change over [an] already-advanced staffing model," the value of which might only be minimal at best, they say.

A total of 3279 ICU patients were admitted during the course of the study and followed up for survival rates for a median 347 days. After adjustment for potential confounders, long-term survival did not differ significantly after the full-time staffing model was introduced compared with before, with an adjusted hazard ratio for death of 1.05.

At the approximate 6-month follow up, a respective 34 and 47 patients treated before and after implementation of the staffing change, or a close family member, completed the Short Form-36 Quality of Life Survey.

The researchers observed significantly improved patient physical composite score after the mandatory staff member was engaged at the ICU, at a mean increase of 8 compared with 2 in the on-demand group. Particular composites that improved included role limitations due to physical problems and vitality. The team noted no difference in mental composite score.

Despite their results, Gajic et al believe their study "remains interesting and hypothesis-generating for future, more definitive studies on QoL and mandatory continuous intensivist coverage of ICU."

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