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Daytime Intensivist

Maged A Tanios, Daniel Teres, Hyunsoon Park, Antonio Beltran, Arunpal Sehgal, James D Leo
BACKGROUND: Various intensivist staffing models have been suggested, but the long-term sustainability and outcomes vary and may not be sustained. We examined the impact of implementing a high-intensity intensivist coverage model with a nighttime in-house nocturnist (non-intensivist) and its effect on intensive care unit (ICU) outcomes. METHODS: We obtained historical control baseline data from 2007 to 2011 and compared the same data from 2011 to 2015. The Acute Physiological and Chronic Health Evaluation outcomes system was utilized to collect clinical, physiological, and outcome data on all adult patients in the medical ICU and to provide severity-adjusted outcome predictions...
January 1, 2018: Journal of Intensive Care Medicine
Megan Galloway, Aoife Hegarty, Sarah McGill, Nishkantha Arulkumaran, Stephen J Brett, David Harrison
OBJECTIVES: Organizational factors are associated with outcome of critically ill patients and may vary by time of day and day of week. We aimed to identify the association between out-of-hours admission to critical care and mortality. DATA SOURCES: MEDLINE (via Ovid) and EMBASE (via Ovid). STUDY SELECTION: We performed a systematic search of the literature for studies on out-of-hours adult general ICU admission on patient mortality. DATA EXTRACTION: Meta-analyses were performed and Forest plots drawn using RevMan software...
February 2018: Critical Care Medicine
Meghan B Lane-Fall, Tara S Ramaswamy, Sydney E S Brown, Xu He, Jacob T Gutsche, Lee A Fleisher, Mark D Neuman
OBJECTIVE: Cardiac surgery ICU characteristics and clinician staffing patterns have not been well characterized. We sought to describe Pennsylvania cardiac ICUs and to determine whether ICU characteristics are associated with mortality in the 30 days after cardiac surgery. DESIGN: From 2012 to 2013, we conducted a survey of cardiac surgery ICUs in Pennsylvania to assess ICU structure, care practices, and clinician staffing patterns. ICU data were linked to an administrative database of cardiac surgery patient discharges...
September 2017: Critical Care Medicine
Kwadwo Kyeremanteng, Ariel Hendin, Kalpana Bhardwaj, Kednapa Thavorn, Dave Neilipovitz, Dalibour Kubelik, Gianni D'Egidio, Grant Stotts, Erin Rosenberg
INTRODUCTION: With an aging population and increasing numbers of intensive care unit admissions, novel ways of providing quality care at reduced cost are required. Closed neurointensive care units improve outcomes for patients with critical neurological conditions, including decreased mortality and length of stay (LOS). Small studies have demonstrated the safety of intermediate-level units for selected patient populations. However, few studies analyze both cost and safety outcomes of these units...
January 1, 2017: Journal of Intensive Care Medicine
Alon Geva, Christopher P Landrigan, Meredith G van der Velden, Adrienne G Randolph
OBJECTIVE: Despite widespread adoption of in-house call for ICU attendings, there is a paucity of research on optimal scheduling of intensivists to provide continuous on-site coverage. Overnight call duties have traditionally been added onto 7 days of continuous daytime clinical service. We designed an alternative ICU staffing model to increase continuity of attending physician care for patients while also decreasing interruptions to attendings' nonclinical weeks. DESIGN: Computer-based simulation of a 1-year schedule...
July 2017: Critical Care Medicine
Nicholas Hinds, Amit Borah, Erika J Yoo
PURPOSE: To compare outcomes of patients refused medical intensive care unit (MICU) admission overnight to those refused during the day and to examine the impact of the intensivist in triage. MATERIALS AND METHODS: Retrospective, observational study of patients refused MICU admission at an urban university hospital. RESULTS: Of 294 patients, 186 (63.3%) were refused admission overnight compared to 108 (36.7%) refused during the day. Severity-of-illness by the Mortality Probability Model was similar between the two groups (P=...
June 2017: Journal of Critical Care
Meeta Prasad Kerlin, Neill K J Adhikari, Louise Rose, M Elizabeth Wilcox, Cassandra J Bellamy, Deena Kelly Costa, Hayley B Gershengorn, Scott D Halpern, Jeremy M Kahn, Meghan B Lane-Fall, David J Wallace, Curtis H Weiss, Hannah Wunsch, Colin R Cooke
BACKGROUND: Studies of nighttime intensivist staffing have yielded mixed results. GOALS: To review the association of nighttime intensivist staffing with outcomes of intensive care unit (ICU) patients. METHODS: We searched five databases (2000-2016) for studies comparing in-hospital nighttime intensivist staffing with other nighttime staffing models in adult ICUs and reporting mortality or length of stay. We abstracted data on staffing models, outcomes, and study characteristics and assessed study quality, using standardized tools...
February 1, 2017: American Journal of Respiratory and Critical Care Medicine
Hayley B Gershengorn, David A Harrison, Allan Garland, M Elizabeth Wilcox, Kathryn M Rowan, Hannah Wunsch
Importance: The patient-to-intensivist ratio (PIR) across intensive care units (ICUs) is not standardized and the association of PIR with patient outcome is not well established. Understanding the impact of PIR on outcomes is necessary to optimize senior medical staffing and deliver high-quality care. Objective: To test the hypotheses that: (1) there is significant variation in the PIR across ICUs and (2) higher PIRs are associated with higher hospital mortality for ICU patients...
March 1, 2017: JAMA Internal Medicine
Rachel Kohn, Vanessa Madden, Jeremy M Kahn, David A Asch, Amber E Barnato, Scott D Halpern, Meeta Prasad Kerlin
RATIONALE: Several intensive care unit (ICU) organizational practices have been associated with improved patient outcomes. However, the uptake of these evidence-based practices is unknown. OBJECTIVES: To assess diffusion of ICU organizational practices across the state of Pennsylvania. METHODS: We conducted two web-based, cross-sectional surveys of ICU organizational practices in Pennsylvania acute care hospitals, in 2005 (chief nursing officer respondents) and 2014 (ICU nurse manager respondents)...
February 2017: Annals of the American Thoracic Society
Stephen M Pastores, John M Oropello, Neil A Halpern, Vladimir Kvetan
No abstract text is available yet for this article.
May 2016: Critical Care Medicine
Hayley B Gershengorn, Allan Garland
Critical illness does not keep to regular, daytime business hours; we must provide high-quality care and support for intensive care unit (ICU) patients 24 hours per day, 7 days per week. Whether this mandates the presence of similar numbers and types of personnel throughout all hours of the day, however, has been the subject of much debate and substantial research. In this article, we review the available literature on the consequences of having three groups of care providers at a patient's bedside overnight: physicians, visitors, and nurses...
February 2016: Seminars in Respiratory and Critical Care Medicine
Deena Kelly Costa, David J Wallace, Jeremy M Kahn
OBJECTIVE: Daytime intensivist physician staffing is associated with improved outcomes in the ICU. However, it is unclear whether this association persists in the era of interprofessional, protocol-directed critical care. We sought to reexamine the association between daytime intensivist physician staffing and ICU mortality and determine if interprofessional rounding and protocols for mechanical ventilation in part mediate this relationship. DESIGN: Retrospective cohort study of ICUs in the Acute Physiology and Chronic Health Evaluation clinical information system from 2009 to 2010...
November 2015: Critical Care Medicine
Amjad Al-Rajhi, Louay Mardini, Dev Jayaraman
BACKGROUND: Rapid response teams (RRTs) were developed to promote assessment of and early intervention for clinically deteriorating hospitalized patients. Although the ideal composition of RRTs is not known, their implementation does require significant resources. OBJECTIVE: To test the effectiveness of a dedicated daytime/weekday intensive care unit (ICU) consult service without formal training of ward teams. METHODS: Pre- and postintervention study with weekends/nights during implementation period acting as a concurrent control...
August 2016: Journal of Intensive Care Medicine
Meeta Prasad Kerlin, Michael O Harhay, Jeremy M Kahn, Scott D Halpern
BACKGROUND: Evidence regarding nighttime physician staffing of ICUs is suboptimal. We aimed to determine how nighttime physician staffing models influence patient outcomes. METHODS: We performed a multicenter retrospective cohort study in a multicenter registry of US ICUs. The exposure variable was the ICU's nighttime physician staffing model. The primary outcome was hospital mortality. Secondary outcomes included new limitations on life support, ICU length of stay, hospital length of stay, and duration of mechanical ventilation...
April 2015: Chest
Elisa Richter, Valery Blasco, François Antonini, Marc Rey, Laurent Reydellet, Karim Harti, Cyril Nafati, Jacques Albanèse, Marc Leone
BACKGROUND: Sleep disorders can affect the health of physicians and patient outcomes. OBJECTIVES: To determine the prevalence of sleep disorders among French anaesthesiologists and intensivists working in a public hospital. DESIGN: A cross-sectional survey. SETTING: Anaesthesiologists and intensivists working in French public hospitals. MAIN OUTCOME MEASURES: Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) was used to assess the degree of excessive daytime sleepiness...
February 2015: European Journal of Anaesthesiology
Salim Baharoon, Walid Alyafi, Hani Tamim, Hamdan Al-Jahdali, Eman Alsafi, Abdullah Al-Sayyari, Qanta Ahmed
OBJECTIVE: The aim of this study was to compare the impacts on patient outcomes of continuous versus on-demand access to certified consultant intensivists in the intensive care unit (ICU). METHODS: Two general adult ICUs within the same health-care organization were compared in terms of patient outcomes. One unit featured continuous mandatory presence of a consultant intensivist (unit A), whereas the other had continuous access to a consultant intensivist during daytime hours but only on-demand access during the night-time hours (unit B)...
June 2016: Journal of Patient Safety
Lora A Reineck, David J Wallace, Amber E Barnato, Jeremy M Kahn
INTRODUCTION: Intensive care units (ICUs) are increasingly adopting 24-hour intensivist physician staffing. Although nighttime intensivist staffing does not consistently reduce mortality, it may affect other outcomes such as the quality of end-of-life care. METHODS: We conducted a retrospective cohort study of ICU decedents using the 2009-2010 Acute Physiology and Chronic Health Evaluation clinical information system linked to a survey of ICU staffing practices...
2013: Critical Care: the Official Journal of the Critical Care Forum
M Elizabeth Wilcox, Christopher A K Y Chong, Daniel J Niven, Gordon D Rubenfeld, Kathryn M Rowan, Hannah Wunsch, Eddy Fan
OBJECTIVE: To determine the effect of different intensivist staffing models on clinical outcomes for critically ill patients. DATA SOURCES: A sensitive search of electronic databases and hand-search of major critical care journals and conference proceedings was completed in October 2012. STUDY SELECTION: Comparative observational studies examining intensivist staffing patterns and reporting hospital or ICU mortality were included. DATA EXTRACTION: Of 16,774 citations, 52 studies met the inclusion criteria...
October 2013: Critical Care Medicine
Meeta Prasad Kerlin, Dylan S Small, Elizabeth Cooney, Barry D Fuchs, Lisa M Bellini, Mark E Mikkelsen, William D Schweickert, Rita N Bakhru, Nicole B Gabler, Michael O Harhay, John Hansen-Flaschen, Scott D Halpern
BACKGROUND: Increasing numbers of intensive care units (ICUs) are adopting the practice of nighttime intensivist staffing despite the lack of experimental evidence of its effectiveness. METHODS: We conducted a 1-year randomized trial in an academic medical ICU of the effects of nighttime staffing with in-hospital intensivists (intervention) as compared with nighttime coverage by daytime intensivists who were available for consultation by telephone (control). We randomly assigned blocks of 7 consecutive nights to the intervention or the control strategy...
June 6, 2013: New England Journal of Medicine
Arjun Pennathur
Postoperative critical care provided by critical care specialists, or intensivists, improves outcomes after surgery. Although there are data supporting daytime intensivist coverage in the intensive care unit, it is not clear how nighttime specialist coverage impacts the quality of care or outcomes. Many surgical intensive care units have adopted continuous 24-hour critical care coverage. Here, we highlight an important study by Wallace and colleagues that reports the impact of nighttime intensivist staffing on outcomes in critically ill patients...
2012: Seminars in Thoracic and Cardiovascular Surgery
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