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Nighttime intensivist staffing and the timing of death among ICU decedents: A retrospective cohort study

Reineck, LA and Wallace, DJ and Barnato, AE and Kahn, JM (2013) Nighttime intensivist staffing and the timing of death among ICU decedents: A retrospective cohort study. Critical Care, 17 (5). ISSN 1364-8535

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Abstract

Introduction: Intensive care units (ICUs) are increasingly adopting 24-hour intensivist physician staffing. Although nighttime intensivist staffing does not consistently reduce mortality, it may affect other outcomes such as the quality of end-of-life care.Methods: We conducted a retrospective cohort study of ICU decedents using the 2009-2010 Acute Physiology and Chronic Health Evaluation clinical information system linked to a survey of ICU staffing practices. We restricted the analysis to ICUs with high-intensity daytime staffing, in which the addition of nighttime staffing does not influence mortality. We used multivariable regression to assess the relationship between nighttime intensivist staffing and two separate outcomes potentially related to the quality of end-of-life care: time from ICU admission to death and death at night.Results: Of 30,456 patients admitted to 27 high-intensity daytime staffed ICUs, 3,553 died in the hospital within 30 days. After adjustment for potential confounders, admission to an ICU with nighttime intensivist staffing was associated with a shorter duration between ICU admission and death (adjusted difference: -2.5 days, 95% CI -3.5 to -1.5, p-value < 0.001) and a decreased odds of nighttime death (adjusted odds ratio: 0.75, 95% CI 0.60 to 0.94, p-value 0.011) compared to admission to an ICU without nighttime intensivist staffing.Conclusions: Among ICU decedents, nighttime intensivist staffing is associated with reduced time between ICU admission and death and reduced odds of nighttime death. © 2013 Reineck et al.; licensee BioMed Central Ltd.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Reineck, LA
Wallace, DJwallaced@pitt.eduWALLACED0000-0003-0314-1004
Barnato, AE
Kahn, JMjeremykahn@pitt.eduJMK1900000-0001-9688-5576
Date: 3 October 2013
Date Type: Publication
Journal or Publication Title: Critical Care
Volume: 17
Number: 5
DOI or Unique Handle: 10.1186/cc13033
Schools and Programs: Graduate School of Public Health > Health Policy & Management
School of Medicine > Critical Care Medicine
School of Medicine > Emergency Medicine
Refereed: Yes
ISSN: 1364-8535
Date Deposited: 02 Dec 2016 17:16
Last Modified: 01 Jul 2019 14:55
URI: http://d-scholarship.pitt.edu/id/eprint/29673

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