Not all ICUs need a specialist at night study

The results published in the New England Journal of Medicine counter an argument from some in the medical community that ICUs need roundtheclock intensivists doctors who specialize in critical care

quotOur knee jerk reaction is to try to put intensivists in every ICU at all hours of the day and that reaction is likely a misstep because it oversimplifies the issuequot said Dr Jeremy Kahn senior author of the study and a professor at the University of Pittsburgh School of Medicine

Most research has shown that having an intensivist in an ICU during the day improves the chances that patients will survive said Kahn

quotTheres been this movement to say well we need to be there at night tooquot said Dr Allan Garland a professor at the University of Manitoba in Winnipeg Canada who was not involved in the study quotBut what there hasnt been is much dataquot

Data are important when it comes to staffing ICUs considering there are not enough intensivists to go around and they are a much more expensive staff member than say a nurse

Kahn said just half of all ICUs in the United States have access to a critical care specialist

And several earlier studies on the impact of nighttime intensivists have had mixed results

To try to get a clearer picture of how much they help patients survive Kahns group examined a larger group of ICUs

They collected information from 49 ICUs across the US covering more than 65000 patients

Twelve of the ICUs had an intensivist on staff at night while the other 37 did not

About 13 out of every 100 patients in the ICUs died within the hospital or went from the ICU to hospice care regardless of whether there was an intensivist available at night or not

But when the researchers divided the ICUs into two categories those that had intensivists overseeing patient care during the day and those that did not Kahns group got a different answer

Among the 22 ICUs with no intensivist during the day having one at night was tied to a 38 percent lower patient death rate than in ICUs without a day or nighttime intensivist

quotThe results of this large study seem to support previously observed associations between overall higher intensity staffing and lower mortalityquot said Dr Ognjen Gajic a professor at the Mayo Clinic in Rochester MN who did not participate in this research

Not all studies have agreed on this association Gajic added in an email to Reuters Health

Despite the new reports finding that a nighttime intensivist makes a difference if theres none during the day the converse was not true Among ICUs with an intensivist during the day the percentage of patients who died within the hospital was the same regardless of whether an intensivist was also present at night

Kahn said the findings suggest that the good intensivists do during the day carries over into the night

Its not so much that the benefits are coming from emergency lifesaving procedures in the wee hours he explained

Rather the difference intensivists make comes from quotmuch more routine banal systematic things like high quality preventive medicine ventilator management and most of these things can be done effectively during the day And once youve implemented all the evidencedbased practices during the day then what you do at night has little impactquot said Kahn

Gajic said its possible the ICUs that have intensivists on staff during the day might also have access to those doctors at night because they are on call

But without knowing the particular arrangements at each hospital its unclear why ICUs with daytime intensivists dont benefit from having them at night he said

Garland said theres a need for more research on different staffing scenarios

quotOne of the things that we would like to see is a consensus Youre much more confident of a result when youve had different studiesall give you the same answer I think its fair to say that we dont yet have that with respect to how intensivists should be involved in ICUsquot Garland told Reuters Health

Kahn said there might be legitimate reasons to have a nighttime specialist in the ICU such as for training purposes

But to improve the chances that patients will leave the ICU alive it doesnt appear that every ICU needs an intensivist at all hours

quotFor ICUs that have very robust daytime staffing they should seriously reexamine the reasons that theyre moving towards 24hour intensivists because it appears that theres little if any marginal gain in survival and those resources may be better deployed in other hospitalsquot Kahn told Reuters Health

Date : 22 May, 2012
Reference : uk.reuters.com/article/2012/05/21/us-icus-specialist-idUKBRE84K13O20120521

Back to Article
Featured Hospitals Listing
St. Stephen's Hospital
St. Stephen's Hospital Marg Tis Hazari Delhi Delhi (India)
Phone : 23966021 - 27
Email : mail@ststephenshospital.org
Website URL : Available