Patient outcomes unaffected by nighttime ICU docs

Although a third of the nation's academic hospitals use intensivist staffing at night to help improve outcomes, nighttime intensivists don't benefit patients and may unnecessarily increase costs, according to a study published online yesterday in the New England Journal of Medicine.

Researchers looked at more than 1,500 patients admitted to the Hospital of the University Pennsylvania Medical ICU and found nighttime intensivist staffing had no significant benefits on ICU or hospital length of stay, ICU or hospital mortality, readmission to the ICU, or discharge to home.

Moreover, the researchers found staffing a nighttime physician in the ICU did not improve outcomes for patients admitted at night or with the most severe illness at the time of admission.

"This tells me that residents and nurses are well qualified and completely competent to handle these patients. As long as nurses and residents have access to an on-call attending physician, then the patient will do as well as if the senior doctor was at their bedside," first author Meeta Prasad Kerlin, M.D., of Perelman School of Medicine at the University of Pennsylvania said yesterday in the research announcement.

However, the researchers noted having nighttime intensivists could improve staff satisfaction and patient experience or reduce physician burn-out and the incidence of malpractice claims.

The findings counter an NEJM study from the University of Pittsburgh published a year ago, which found using nighttime intensivist physician staffing in ICUs with a low-intensity daytime staffing model reduces mortality.

With hospitals looking to keep constant tabs on their most critical patients, some rely on remote eICUs to help offer nighttime ICU coverage. But as with nighttime intensivists, some studies question whether eICUs improve patient outcomes or provide a return on investment.

For more:
- here's the NEJM abstract
- check out the research announcement