Research Activities January 2013, No. 389
24-hour staffing of intensive care units with intensivists has benefits as well as some tradeoffs for patients and physicians
More and more hospitals are favoring 24-hour attending physician coverage in their intensive care units (ICUs), with some even opting for remote telemonitoring. While there are many benefits to having experienced intensivists present all the time, it may also produce some unintended consequences for patients, suggests a paper by University of Pennsylvania critical care medicine specialists, Meeta Prasad Kerlin, MD, MSCE, and Scott D. Halpern, MD, PhD.
In a recent essay, they explore both the pros and possible cons associated with 24-hour intensivist staffing in teaching hospitals. Their opinions suggest that such coverage requires tradeoffs in training of residents (individuals with a medical degree but who practice under the supervision of fully licensed physicians, such as hospital attending physicians) and possible disparities in health care access at certain hospitals that cannot attract the limited number of intensivists.
Intensivist staffing on a 24-hour basis has several potential benefits for patients. These experienced specialists may improve the quality and efficiency of care, while at the same time increasing the satisfaction levels of families and staff. In addition, lowering on-call responsibility may reduce staff burn out. Some studies even suggest that patients who receive such high-intensity critical care have reduced mortality and shorter length of stays compared to patients in ICUs with other staffing models. Also, nurses appreciate having the intensivist present in the ICU, since it reduces communication delays when trying to reach a physician by phone.
However, the current shortage of intensivists means that not all critically ill patients can benefit from this type of care and staffing. Some ICUs have no intensivists at all. This 24-hour staffing trend may result in more specialists being taken away from hospitals who need them the most. Residents may also not have as many opportunities to learn by doing in the environment of round-the-clock intensivist coverage. Lesser autonomy may make residents feel less fulfilled, discouraging them from pursuing careers as intensivists. Given all of the questions surrounding this type of ICU staffing model, the authors recommend randomized trials comparing 24-hour versus daytime-only intensivist staffing. The study was supported in part by the Agency for Healthcare Research and Quality (HS018406).
See "Twenty-four-hour intensivist staffing in teaching hospitals: Tensions between safety today and safety tomorrow," by Drs. Kerlin and Halpern in the May 2012 Chest 141(5), pp. 1315-1320.