ICU administration · Overnight intensivist presence
A randomized trial of nighttime physician staffing in an intensive care unit
| Design | Randomised controlled trial |
|---|---|
| Treatment | In-hospital intensivist present overnight |
| Control | Intensivist available by telephone overnight |
| Population | 1598 patients in an academic medical intensive care unit |
| Follow-up | Hospital discharge |
| Primary endpoint | ICU length of stay |
| Result | Patients admitted on intervention days were exposed to nighttime intensivists on a median 100% of nights versus 0% on control days (p<0.001). Despite that, nighttime intensivist staffing did not significantly affect ICU length of stay (median 52.7 hours overall), ICU mortality (18% overall) or any other outcome. Median APACHE III score was 67. |
| Secondary endpoints | ICU and in-hospital mortality, readmission, discharge disposition |
In an academic medical ICU in the United States, nighttime in-hospital intensivist staffing did not improve patient outcomes.
The trial authors, in the published abstract
Expensive, widely assumed to be beneficial, and randomised only once. The setting matters: an academic unit with resident cover overnight already had experienced clinicians present, so the marginal value of the consultant was small.
Kerlin MP, Small DS, Cooney E, et al. A randomized trial of nighttime physician staffing in an intensive care unit. N Engl J Med 2013 Jun 6;368(23):2201-9.