7/28/2019 Critical Care Nursing Article

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Colette S. Llantino III

BSN 4-3

Article:

Having a Nighttime Critical Care Physician in the ICU Doesn’t Improve Patient Outcomes (5/20/2013)

 Newswise — PHILADELPHIA — With little evidence to guide them, many hospital intensive

care units (ICUs) have been employing critical care physicians at night with the notion it would

improve patients’ outcomes. However, new results from a one-year randomized trial from

researchers at Penn Medicine involving nearly 1,600 patients admitted to the Hospital of the

University Pennsylvania (HUP) Medical ICU suggest otherwise: Having a nighttime intensivist

had no clear benefit on length of stay or mortality for these patients, not even patients admitted at

night or those with the most critical illnesses at the time of admission.

The research will be presented at the American Thoracic Society International Conference in

Philadelphia on May 20 by senior study author Scott D. Halpern, MD, PhD, assistant professor 

of Medicine, Epidemiology, and Medical Ethics and Health Policy, and published online the

same day in the New England Journal of Medicine.

The findings raise a pertinent question in today's financially-conscious healthcare setting: Why

invest financial resources to staff a nighttime intensivist if it’s not improving patient outcomes?

“This is an important finding that affects a lot of stakeholders,” said first author Meeta Prasad

Kerlin, MD, MSCE, an assistant professor of Medicine in the division of Pulmonary, Allergy and

Critical Care at the Perelman School of Medicine at the University of Pennsylvania. “Staffing an

intensivist 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.” 

“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,” she added. “In fairness, this study doesn't tell us what might happen with nighttime

intensivists in ICUs that aren't like Penn's.” 

Today, one third of academic hospitals in the U.S. and three quarters in Europe staff a nighttime

 physician in the ICU, despite a lack of clear evidence demonstrating its effectiveness. Previous

studies on the topic lacked experimental designs and produced mixed results.

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Reaction:

The article deals with having a critical care physician during night time and its effect and

development to patients in the ICU. Even though I’ve been dumbfounded in intensive care

nursing for a while, I find reading the article an opportunity to explore more about critical care.

The article was particularly interesting because it combined compelling theories with good

 judgment, a component that I am inherently interested in. The article has a really great example

of a research.

Based on the article that I have read, I was also thinking that it is somehow true that night

time critical care physician during night time doesn’t promote the patient’s condition because

Meeta Prasad Kerlin, MD, MSCE, an assistant professor of Medicine in the division of 

Pulmonary, Allergy and Critical Care at the Perelman School of Medicine at the University of 

Pennsylvania said that, “Staffing an intensivist 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.” Therefore

it will cost more on the patient for paying the physician and on the hospital for hiring abundant

staff of physicians. The only ones who will benefit from this night time critical care physicians

would be the residents of the hospital who’s gaining a lot of information and knowledge from

them since the night time critical physicians will help them deal with their patients.

I was also intrigued by the article on how it said that it might be different from the

Hospital of the University Pennsylvania (HUP) Medical ICU. But the article tells us that, “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.”  

I am also a little confused up until now, if there is an excess amount of night time critical

care physicians. On the other hand, it just proves that residents and nurses can handle the patients

competently and efficiently without a physician every second of the day. Even if it’s good or bad

result from the research, it is still confirming the fact on the development of the patient is stifle.

Would the researchers find a comeback to what will finally enhance the situation of the patients

in an ICU during night time? This seems like a good follow-up study.