Should Quality of Care Provided by Nighttime Intensivists Be Judged by Mortality?

We read in earnest the retrospective study by Kerlin et al 1 in the recent issue of CHEST (April 2015), which found that nighttime intensivist staffi ng is not associated with a reduction in ICU or hospital mortality rate and overall length of stay. Th is study, as the authors noted, supports the existing body of work, from a single-center randomized controlled trial, multicentered observational study, and meta-analysis, that shows this staffi ng model failing to improve upon patient-centered outcomes such as mortality rate and length of stay in high-intensity daytime staff ed ICUs. 1 Other clinical end points outside of patientcentered outcomes, such as reduced fi nancial costs 2 and reduced physician burnout, 3 have also been examined.