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Higher Intensivist Staffing Levels Linked to Fewer ICU Deaths

Cheryl Clark, for HealthLeaders Media, November 19, 2013

A meta-analysis into guidelines that call for "high-intensity staffing" models employing intensivists in the ICU reveals better patient outcomes, but not at night.

Staffing hospital intensive care units with more intensivists resulted in fewer in-hospital deaths and lower lengths of both hospital and ICU stays when compared with having fewer intensivists.

But no improvements in mortality or length of stay were seen with staffing the ICU with intensivists at night, an expensive and difficult task for most hospitals because such certified specialists are in extremely short supply across North America.

Those are the conclusion from a meta-analysis study by Toronto researchers who analyzed 52 observational cohorts in North America treated over more than 50 years, or about 331,222 patients. They wanted to determine if putting critical care specialists in charge of ICUs staffed around the clock resulted in better patient outcomes. The report was published in the October edition of the journal Critical Care Medicine.

The issue is a controversial one because current North American and European guidelines recommend that so called "high-intensity staffing models" in which intensivists take over the care of these patients, is the most suitable model for ICU care. Those guidelines also suggest that coverage should extend around the clock.

But those guidelines belie the reality of daily operations for most hospitals, which allow any physician to oversee patient care in the ICU, "and an intensivist may or may not be available for consultation."

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