Round-the-clock ICU intensivists could reduce mortality rates, length of stay

Implementing 24-hour intensivists at medical intensive care units (ICUs) could reduce patient mortality rates, and significantly reduce patients' length of stay, indicate study results.

"Our results can provide physicians, hospital administrators and other stakeholders with guidance when making decisions about staffing in their individual institutions," say Eric Papierniak and colleagues from the University of Florida, Gainesville, USA, who presented their results at Chest 2012 in Atlanta, Georgia, USA.

The team conducted a retrospective observational study of records from the 24-bed medical ICU at their institution between July 2009 and June 2012, covering the two transitions in nighttime staff, at 7pm and 7am.

Up to June 2010, night shifts were staffed by interns and residents with senior staff members on call, and after this point, 24-hour intensivist staffing was implemented.

The researchers report a total of 3593 patient admissions during the entire study period; 1439 patients during the year before the staffing change and 2519 patients during the 1.5 years afterward.

A respective 235 and 365 deaths occurred during the pre- and post-intensivist time periods, representing a near-significant mortality rate decrease of 0.163 to 0.144, report Papierniak et al.

In addition, length of ICU stay significantly decreased after implementation of round-the-clock intensivist staffing, they note, reducing by nearly one half-day from 4.50 to 4.09 days.

Commenting on the study, co-author Ibrahim Faruqi suggested that this finding could represent a cost saving.

"Multiple studies have demonstrated improved outcomes in the intensive care unit when care is guided by critical care-trained specialists," says the research team.

On the basis of their findings Papierniak et al "recommend round-the-clock intensivist presence in all large medical ICU's," recognizing that large prospective studies are needed to confirm their results.

Commenting on the study in a statement to the press, Papierniak remarked that the study is unique since it also collected data on palliative care and hospice referrals, as well as comparing residents versus fellow as providers of nighttime critical care.

He noted that such referrals rose significantly after implementing intensivist care, from 3.7 per month to 9.5 per month.

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