Night-time intensivists - waste of resources or failure of process optimization?

Dr Levy [1] commented on the study of Kerlin and colleagues [2] on the relevance, or futility, of night-time intensivists. Kerlin and colleagues compared in-hospital night-time intensivist presence with night-time phone consultations by daytime intensivists (control) with regard to ICU length of stay, hospital mortality, and readmission rate. Randomized 7 day blocks of night-time intensivist presence versus control had no effect. Previously, Dr Levy found no association between high-intensity daytime staffing and mortality, and no benefit of night-time intensivists in high-intensity ICUs in a retrospective study [3]. Dr Levy suggests that 'it is time...to redirect the resources proposed for night-time intensivists elsewhere'. Conclusions on night-time intensivists, based on these two studies [2,3] may be misleading and premature. Failure of specific resources in the ICU to influence outcomes is nothing new monitoring technologies offer a prime example [4]. Resources, per se, make no difference,