A Retrospective Cohort Study
نویسندگان
چکیده
BACKGROUND: Evidence regarding nighttime physician staffi ng of ICUs is suboptimal. We aimed to determine how nighttime physician staffi ng models infl uence patient outcomes. METHODS: We performed a multicenter retrospective cohort study in a multicenter registry of US ICUs. Th e exposure variable was the ICU’s nighttime physician staffi ng model. Th e primary outcome was hospital mortality. Secondary outcomes included new limitations on life support, ICU length of stay, hospital length of stay, and duration of mechanical ventilation. Daytime physician staffi ng was studied as a potential eff ect modifi er. RESULTS: Th e study included 270,742 patients in 143 ICUs. Compared with nighttime staffi ng with an attending intensivist, nighttime staffi ng without an attending intensivist was not associated with hospital mortality (OR, 1.03; 95% CI, 0.92-1.15; P 5 .65). Th is relationship was not modifi ed by daytime physician staffi ng (interaction P 5 .19). When nighttime staffi ng was subcategorized, neither attending nonintensivist nor physician trainee staffi ng was associated with hospital mortality compared with attending intensivist staffi ng. However, nighttime staffi ng without any physician was associated with reduced odds of hospital mortality (OR, 0.79; 95% CI, 0.68-0.91; P 5 .002) and new limitations on life support (OR, 0.83; 95% CI, 0.75-0.93; P 5 .001). Nighttime staffi ng was not associated with ICU or hospital length of stay. Nighttime staffi ng with an attending nonintensivist was associated with a slightly longer duration of mechanical ventilation (hazard ratio, 1.05; 95% CI, 1.02-1.09; P , .001). CONCLUSIONS: We found little evidence that nighttime physician staffi ng models aff ect patient outcomes. ICUs without physicians at night may exhibit reduced hospital mortality that is possibly attributable to diff erences in end-of-life care practices. CHEST 2015; 147(4): 951 958 [ Original Research Critical Care Medicine ]
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تاریخ انتشار 2015