The authors, led by M. Elizabeth Wilcox, MD, of the Division of Critical Care Medicine at the University of Toronto, said that if lower mortality and length of stay can be achieved with a high-intensity model that doesn't involve night time coverage, "we might achieve similar improvements while allowing sufficient time for workforce growth to meet current and future demands."
Robert Wachter, MD, UCSF Chief of the Division of Hospital Medicine and Chief of Medical Service, suggests that the meta-analysis may give a hint that a solution has to do with the ICU culture.
"One could argue that what you're seeing here by having an intensivist there all day long, even when the intensivist is not there to manage every single thing, there are practice patterns, the way people escalate care, their philosophy, and the way they approach quality improvement" that make the difference, without the expense of nighttime intensivist staffing, he said.
"When the staff sees something broken, do they just sort of find a work-around, or do they actually fix it and have confidence that when there's a system glitch, they report it to the appropriate people because then someone will look into it the next day," Wachter said.
The authors say that their analysis was somewhat hampered by some differences, which they describe as "the myriad of staffing patterns currently in practice," and other "confounding factors influencing care delivery, such as the presence of nonintensivist physician providers, type of bedside nursing care, specialty teams, regionalization of medical care, and a lack of standard definitions for ICU administration and management."