title: Continuity of care in intensive care units: a cluster-randomized trial of intensivist staffing.
abstract: BACKGROUND
  Little is known about the consequences of intensivists’ work schedules, or intensivist continuity of care.
  
  
  OBJECTIVE
  To assess the impact of weekend respite for intensivists, with consequent reduction in continuity of care, on them and their patients.
  
  
  METHODS
  In five medical intensive care units (ICUs) in four academic hospitals we performed a prospective, cluster-randomized, alternating trial of two intensivist staffing schedules. Daily coverage by a single intensivist in half-month rotations (continuous schedule) was compared with weekday coverage by a single intensivist, with weekend cross-coverage by colleagues (interrupted schedule). We studied consecutive patients admitted to study units, and the intensivists working in four of the participating units.
  
  
  RESULTS
  The primary patient outcome was ICU length of stay (LOS);we also assessed hospital LOS and mortality rates. The primary intensivist outcome was physician burnout. Analysis was by multivariable regression. A total of 45 intensivists and 1,900 patients participated in the study. Continuity of care differed between schedules (patients with multiple intensivists = 28% under continuous schedule vs. 62% under interrupted scheduling; P < 0.0001). LOS and mortality were nonsignificantly higher under continuous scheduling (ΔICU LOS 0.36 d, P = 0.20; Δhospital LOS 0.34 d, P = 0.71; ICU mortality, odds ratio = 1.43, P = 0.12; hospital mortality, odds ratio = 1.17,P = 0.41). Intensivists experienced significantly higher burnout, work–home life imbalance, and job distress working under the continuous schedule.
  
  
  CONCLUSIONS
  Work schedules where intensivists received weekend breaks were better for the physicians and, despite lower continuity of intensivist care, did not worsen outcomes for medical ICU patients.
authors: Division of Pulmonary, Allergy, Critical CAre and Sleep Medicine, Indiana University, Indianapolis, Indiana, USA.
authors: Naeem A
authors: NA
authors: Ali
authors: Jeffrey
authors: J
authors: Hammersley
authors: Stephen P
authors: SP
authors: Hoffmann
authors: James M
authors: JM
authors: O'Brien
authors: Gary S
authors: GS
authors: Phillips
authors: Mitchell
authors: M
authors: Rashkin
authors: Edward
authors: E
authors: Warren
authors: Allan
authors: A
authors: Garland
mesh_terms: D039602:After-Hours Care; D002055:Burnout, Professional / Q000517:prevention & control; D003266:Continuity of Patient Care; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007902:Length of Stay; D015999:Multivariate Analysis; D010561:Personnel Staffing and Scheduling; D011446:Prospective Studies; D014481:United States; D000078329:Workforce