Nighttime Docs at ICUs Don't Boost Patient Outcomes: Study05/20/13
MONDAY, May 20 (HealthDay News) -- Although many hospital
intensive care units have a nighttime attending physician on staff
to help improve outcomes, new research suggests this may have no
clear benefit to patients.
Since one-third of teaching hospitals in the United States and
three-quarters of hospitals in Europe staff a nighttime physician
in the ICU, the practice may unnecessarily increase health-care
costs while siphoning doctors away from hospitals with fewer
resources, the study authors said.
"Based on these results, if an academic hospital's primary goal is to improve patient outcomes, then I don't think having an attending physician physically there overnight in a medical ICU is necessary," said the study's first author, Dr. Meeta Prasad Kerlin.
"This is an important finding that affects a lot of stakeholders. Staffing an intensivist [attending physician] at night is probably quite costly, because the total billing will likely be at a higher rate, which could trickle down to the insurance provider or patient. There's also the operating cost associated with staffing that impacts hospitals," said Kerlin, an assistant professor of medicine at the University of Pennsylvania School of Medicine's division of pulmonary, allergy and critical care.
The one-year study involved nearly 1,600 patients admitted to
the ICU at the Hospital of the University of Pennsylvania.
The study's senior author, Dr. Scott Halpern, assistant
professor of medicine, epidemiology, and medical ethics and health
policy, and a team of researchers compared overnight ICU staffing.
One staffing group included medical residents and an attending
physician; the other group included an attending physician who was
only available to medical residents by phone. The researchers also
conducted in-hospital follow-up on the patients for 90 days.
The study found that nighttime physicians had no effect on how
long patients stayed in the ICU, how long their hospital stay was,
in-hospital death rates, ICU readmissions or discharge to home. The
researchers said this held true even among the most critically ill
patients or those admitted at night.
"This tells me that residents and nurses are well qualified and completely competent to handle these patients," Kerlin said in a news release from the medical school. "As long as nurses and residents have access to an on-call attending physician, then the patient will do as well as if the senior doctor was at their bedside."
The study also found that medical residents believe nighttime
attending physicians provide needed support and enhance the
doctors'-in-training learning experience. The researchers noted
hospitals may want to consider residents' opinions when making a
decision on this staffing issue.
The study was published online May 20 in the
New England Journal of Medicineto coincide with a
presentation at the American Thoracic Society International
Conference in Philadelphia.
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