Night time Physician Staffing in ICU (Intensive Care Unit) Read the following abstract and explain what it shows. A rate ratio of 1 means there is no difference in rates, and a confidence interval for rate ratios that captures 1 means there is no significant difference in rates. (An intensivist is a doctor who specializes in intensive care.)
We conducted a 1-year randomized trial in an academic medical ICU of the effects of night time staffing with in-hospital intensivists (intervention) as compared with night time coverage by daytime intensivists who were available for consultation by telephone (control). We randomly assigned blocks of 7 consecutive nights to the intervention or the control strategy. The primary outcome wasÂ patientsâ€™ length of stay in the ICU. Secondary outcomes were patientsâ€™ length of stay in the hospital, ICU and in-hospital mortality, discharge disposition, and rates of readmission to the ICU.
A total of 1598 patients were included in the analyses. . . . Patients who were admitted on intervention days were exposed to night time intensivists on more nights than were patients admitted on control days. Nonetheless, intensivist staffing on the night of admission did not have a significant effect on the length of stay in the ICU (rate ratio for the time to ICU discharge, 0.98; 95% confidence interval [CI], 0.88 to 1.09; P = 0.72), on ICU mortality (relative risk, 1.07; 95% CI, 0.90 to 1.28), or on any other end point.
(Source: Meeta Kerlin et al. 2013. A randomized trial of night time physician staffing in an intensive care unit. New England Journal of Medicine 368, 2201â€“2209.)