Presence of Specialist Round the Clock in an ICU does not improve Patient Survival

icu room

Many people as well as physicians believe that putting a specialist in the ICUs round the clock improves the rate of survival of the patients. However, a new study published in the New England Journal of Medicine has found that this is not necessarily true. If there is a specialist in the ICU during the day, putting an intensivist in the ICU does not have any impact on the survival of the patients.

Earlier studies have shown that a specialist trained in critical care improves the outcome of the patients when put in an ICU during day time. This has prompted physicians to call for specialist cover for all critically ill patients around the clock. Those who advocate 24 hour intensivist staffing say that presence of intensivist in the ICU during night can result in earlier establishment of treatment, early resuscitation of serious patients, and more consistent patient related decision making. However, those who oppose this say that it will further add to the cost of treatment and moreover, there are no statistics to support improved patient survival rate.

To test the merits of posting night-time intensivists in the ICU, the researchers, under the leadership of Dr. Jeremy Kahn from the University of Pittsburgh, School of Medicine, collected information from 49 ICUs in the United States from the Acute Physiology and Chronic Health Evaluation (APACHE) clinical outcomes database. It encompassed more than 65,000 patients. Of the 49 ICUs covered, 12 had an intensivist posted during the night while 37 did not have this facility.

It was seen that 13 out of every 100 patients admitted in the ICUs died or were shifted to hospice care. This figure remained the same in all the ICUs irrespective of the fact that whether an intensivist was present in the night shift or not. But where the ICUs lacked a day time intensivist but had one during night, the death rate was 38% lower than in ICUs which did not have any specialist at all. The researchers have concluded that adding a night time specialist to an ICU which already has a day time specialist does not have any impact on the mortality rate of the patients.


Sunday, June 10, 2012
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