ATS: Day, Night Staffing Linked to Mortality in ICU

ICUs with low-intensity daytime staffing have reduced mortality with nighttime intensivist staffing

MONDAY, May 21 (HealthDay News) -- For patients admitted to the intensive care unit (ICU), nighttime intensivist staffing is associated with reduced in-hospital mortality in ICUs that have low-intensity daytime staffing, according to a study published online May 21 in the New England Journal of Medicine to coincide with presentation at the annual meeting of the American Thoracic Society, held from May 18 to 23 in San Francisco.

To investigate whether nighttime intensivist staffing correlates with the quality of ICU care, David J. Wallace, M.D., M.P.H., from the University of Pittsburgh School of Medicine, and colleagues conducted a retrospective cohort study of data from 65,752 patients admitted to 49 ICUs in 25 hospitals participating in the Acute Physiology and Chronic Health Evaluation (APACHE) clinical information system from 2009 through 2010. A confirmatory analysis was conducted in a second population-based cohort of hospitals.

Based on data from the APACHE database, in ICUs with low-intensity daytime staffing, the researchers found that nighttime intensivist staffing correlated with a decrease in the risk-adjusted in-hospital mortality (adjusted odds ratio [OR], 0.62; P = 0.04). For ICUs with high-intensity daytime staffing, nighttime staffing offered no additional benefit to the risk-adjusted in-hospital mortality (OR, 1.08; P = 0.78). A similar association was seen between daytime staffing, nighttime staffing, and in-hospital mortality in the verification cohort, although the interaction between nighttime and daytime staffing was not significant (P = 0.18).

"Our multicenter evaluation showed that nighttime intensivist staffing was associated with reduced in-hospital mortality among patients admitted to ICUs with low-intensity daytime staffing, but with no incremental benefit among patients admitted to ICUs with high-intensity daytime staffing," the authors write.

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