24-hour mandatory versus on-demand critical care specialist presence
Gajic 2008 trial design and results
Design
Prospective before-and-after comparative study
Treatment
Continuous 24-hour on-site academic critical care specialist presence
Control
On-demand specialist presence
Population
2622 patients in the intensive care unit of a teaching hospital — 1301 admitted before and 1321 after the staffing change
Follow-up
Hospital discharge
Primary endpoint
Quality of care processes, and family and provider satisfaction
Result
Non-adherence to evidence-based care processes fell from 24% to 16% per patient-day (p=0.002) and ICU complications from 11% to 7% per patient-day (p=0.023). Adjusted hospital stay shortened by a mean 1.4 days (95% CI -0.3 to -2.5, p=0.017). Adjusted ICU and hospital mortality were similar before and after the staffing change.
Secondary endpoints
ICU complications, family satisfaction, length of stay
The introduction of continuous (24-hr) on-site presence by a staff academic critical care specialist was associated with improved processes of care and staff satisfaction and decreased ICU complication rates.
The trial authors, in the published abstract
How it has aged
Before-and-after rather than randomised, and it measures processes and satisfaction rather than survival. Kerlin 2013 later randomised the question and found no patient benefit, which is the more reliable answer on outcomes.
Publications
Effect of 24-hour mandatory versus on-demand critical care specialist presence on quality of care and family and provider satisfaction in the intensive care unit of a teaching hospital
Gajic O, Afessa B, Hanson AC, et al. Effect of 24-hour mandatory versus on-demand critical care specialist presence on quality of care and family and provider satisfaction in the intensive care unit of a teaching hospital. Crit Care Med 2008 Jan;36(1):36-44.