An official American thoracic society systematic review: The effect of nighttime intensivist staffing on mortality and length of stay among intensive care unit patients

Meeta Prasad Kerlin, Neill K J Adhikari, Louise Rose, M. Elizabeth Wilcox, Cassandra J. Bellamy, Deena Kelly Costa, Hayley B. Gershengorn, Scott D. Halpern, Jeremy M. Kahn, Meghan B. Lane-Fall, David J. Wallace, Curtis H. Weiss, Hannah Wunsch, Colin R. Cooke

Research output: Contribution to journalReview article

20 Citations (Scopus)

Abstract

Background: Studies of nighttime intensivist staffing have yielded mixed results. Goals: To review the association of nighttime intensivist staffing with outcomes of intensive care unit (ICU) patients. Methods: We searched five databases (2000-2016) for studies comparing in-hospital nighttime intensivist staffing with other nighttime staffing models in adult ICUs and reporting mortality or length of stay. We abstracted data on staffing models, outcomes, and study characteristics and assessed study quality, using standardized tools. Meta-analyses used random effects models. Results: Eighteen studies met inclusion criteria: one randomized controlled trial and 17 observational studies. Overall methodologic quality was high. Studies included academic hospitals (n = 10), community hospitals (n = 2), or both (n = 6). Baseline clinician staffing included residents (n = 9), fellows (n = 4), and nurse practitioners or physician assistants (n = 2). Studies included both general and specialty ICUs and were geographically diverse. Meta-analysis (one randomized controlled trial; three nonrandomized studies with exposure limited to nighttime intensivist staffing with adjusted estimates of effect) demonstrated no association with mortality (odds ratio, 0.99; 95% confidence interval, 0.75-1.29). Secondary analyses including studies without risk adjustment, with a composite exposure of organizational factors, stratified by intensity of daytime staffing and by ICU type, yielded similar results. Minimal or no differences were observed in ICU and hospital length of stay and several other secondary outcomes. Conclusions: Notwithstanding limitations of the predominantly observational evidence, our systematic review and meta-analysis suggests nighttime intensivist staffing is not associated with reduced ICU patient mortality. Other outcomes and alternative staffing models should be evaluated to further guide staffing decisions.

Original languageEnglish (US)
Pages (from-to)383-393
Number of pages11
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume195
Issue number3
DOIs
StatePublished - Feb 1 2017

Fingerprint

Intensive Care Units
Length of Stay
Thorax
Meta-Analysis
Mortality
Randomized Controlled Trials
Risk Adjustment
Physician Assistants
Nurse Practitioners
Community Hospital
Observational Studies
Odds Ratio
Outcome Assessment (Health Care)
Databases
Confidence Intervals

Keywords

  • Administration
  • Critical care
  • Intensive care unit
  • Organization
  • Staffing

ASJC Scopus subject areas

  • Medicine(all)
  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

An official American thoracic society systematic review : The effect of nighttime intensivist staffing on mortality and length of stay among intensive care unit patients. / Kerlin, Meeta Prasad; Adhikari, Neill K J; Rose, Louise; Wilcox, M. Elizabeth; Bellamy, Cassandra J.; Costa, Deena Kelly; Gershengorn, Hayley B.; Halpern, Scott D.; Kahn, Jeremy M.; Lane-Fall, Meghan B.; Wallace, David J.; Weiss, Curtis H.; Wunsch, Hannah; Cooke, Colin R.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 195, No. 3, 01.02.2017, p. 383-393.

Research output: Contribution to journalReview article

Kerlin, MP, Adhikari, NKJ, Rose, L, Wilcox, ME, Bellamy, CJ, Costa, DK, Gershengorn, HB, Halpern, SD, Kahn, JM, Lane-Fall, MB, Wallace, DJ, Weiss, CH, Wunsch, H & Cooke, CR 2017, 'An official American thoracic society systematic review: The effect of nighttime intensivist staffing on mortality and length of stay among intensive care unit patients', American Journal of Respiratory and Critical Care Medicine, vol. 195, no. 3, pp. 383-393. https://doi.org/10.1164/rccm.201611-2250ST
Kerlin, Meeta Prasad ; Adhikari, Neill K J ; Rose, Louise ; Wilcox, M. Elizabeth ; Bellamy, Cassandra J. ; Costa, Deena Kelly ; Gershengorn, Hayley B. ; Halpern, Scott D. ; Kahn, Jeremy M. ; Lane-Fall, Meghan B. ; Wallace, David J. ; Weiss, Curtis H. ; Wunsch, Hannah ; Cooke, Colin R. / An official American thoracic society systematic review : The effect of nighttime intensivist staffing on mortality and length of stay among intensive care unit patients. In: American Journal of Respiratory and Critical Care Medicine. 2017 ; Vol. 195, No. 3. pp. 383-393.
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abstract = "Background: Studies of nighttime intensivist staffing have yielded mixed results. Goals: To review the association of nighttime intensivist staffing with outcomes of intensive care unit (ICU) patients. Methods: We searched five databases (2000-2016) for studies comparing in-hospital nighttime intensivist staffing with other nighttime staffing models in adult ICUs and reporting mortality or length of stay. We abstracted data on staffing models, outcomes, and study characteristics and assessed study quality, using standardized tools. Meta-analyses used random effects models. Results: Eighteen studies met inclusion criteria: one randomized controlled trial and 17 observational studies. Overall methodologic quality was high. Studies included academic hospitals (n = 10), community hospitals (n = 2), or both (n = 6). Baseline clinician staffing included residents (n = 9), fellows (n = 4), and nurse practitioners or physician assistants (n = 2). Studies included both general and specialty ICUs and were geographically diverse. Meta-analysis (one randomized controlled trial; three nonrandomized studies with exposure limited to nighttime intensivist staffing with adjusted estimates of effect) demonstrated no association with mortality (odds ratio, 0.99; 95{\%} confidence interval, 0.75-1.29). Secondary analyses including studies without risk adjustment, with a composite exposure of organizational factors, stratified by intensity of daytime staffing and by ICU type, yielded similar results. Minimal or no differences were observed in ICU and hospital length of stay and several other secondary outcomes. Conclusions: Notwithstanding limitations of the predominantly observational evidence, our systematic review and meta-analysis suggests nighttime intensivist staffing is not associated with reduced ICU patient mortality. Other outcomes and alternative staffing models should be evaluated to further guide staffing decisions.",
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