In-House Overnight Physician Staffing in Canadian ICUs
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVES
Overnight physician staffing in the ICU has been recommended by the Society of Critical Care Medicine and the Leapfrog Consortium. We conducted a survey to review practice in the current era and to compare this with results from a 2006 survey.
DESIGN
Cross-sectional survey.
SETTING
Canadian adult ICUs.
PARTICIPANTS
ICU directors.
INTERVENTIONS
None.
MEASUREMENT AND MAIN RESULTS
A 29-question survey was sent to ICU directors describing overnight staffing by residents, fellows, nurse practitioners, and staff physicians, as well as duty duration, clinical responsibilities, and unit characteristics. We established contact with 122 ICU directors, of whom 107 (88%) responded. Of the 107 units, 60 (56%) had overnight in-house physicians. Compared with ICUs without overnight in-house physician coverage, ICUs with in-house physicians were in larger hospitals (p < 0.0001), had more beds (p < 0.0001), had more ventilated patients (p < 0.0001), and had more admissions (p < 0.0001). Overnight in-house physicians were first year residents (R1) in 20 of 60 (33%), second to fifth year residents (R2-R5) in 46 of 60 (77%), and Critical Care Medicine trainees in 19 of 60 (32%). Advanced practice nurses provided overnight coverage in four of 107 ICUs (4%). The most senior in-house physician was a staff physician in 12 of 60 ICUs (20%), a Critical Care Medicine trainee in 14 of 60 (23%), and a resident (R2-R5) in 20 of 60 (33%). The duration of overnight duty was on average 20-24 hours in 22 of 46 units (48%) with R2-R5 residents and 14 of 19 units (74%) covered by Critical Care Medicine trainees.
CONCLUSIONS
Variability of in-house overnight physician presence in Canadian adult ICUs is linked to therapeutic complexity and unit characteristics and has not changed significantly over the decade since our 2006 survey. Additional evidence about patient and resident outcomes would better inform decisions to revise physician scheduling in Canadian ICUs.
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Additional Info
Disclosure statements are available on the authors' profiles:
In-House, Overnight Physician Staffing: A Cross-Sectional Survey of Canadian Adult ICUs
Crit. Care Med. 2020 Oct 07;[EPub Ahead of Print], C Maratta, K Hutchison, GP Moore, SM Bagshaw, J Granton, H Kirpalani, HT Stelfox, N Ferguson, D Cook, CS ParshuramFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.