title: Effect of 24-hour mandatory vs on-demand critical care specialist presence on long-term survival and quality of life of critically ill patients in the intensive care unit of a teaching hospital.
abstract: BACKGROUND
  Mandatory compared with on-demand intensivist presence improves processes of care and decreases intensive care unit (ICU) complication rate and hospital length of stay. The effect of continuous mandatory intensivist coverage on long-term patient mortality and quality of life (QOL) is not known.
  
  
  METHODS
  We compared the long-term survival before (year 2005) and after (year 2006) the intervention when the staffing model changed from on-demand presence to mandatory 24-hour staff-critical care specialist presence in the medical ICU. Baseline and 6-month QOL surveys (SF-36 [short form 36 health survey]) were compared in subgroups of patients admitted before and after the staffing change. Cox proportional hazard and paired statistical analyses were used for survival and QOL comparisons.
  
  
  RESULTS
  The baseline characteristics did not differ significantly between the 2 groups except for race and Acute Physiology and Chronic Health Evaluation III score (median, 30 vs 37; P < .001 before and after the staffing model change). Long-term survival was not significantly different before and after the staffing change-adjusted hazard ratio, 1.05; 95% confidence interval, 0.95 to 1.16; P = .3. In a subset of ICU survivors, SF-36 physical component score improved significantly at 6 months compared with baseline after the staffing model change-Δ mean (SD) 8 (14) vs 2 (11), P = .03. However, there was no difference in the Δ mean mental component score of the SF-36 between the 2 groups (P = .77).
  
  
  CONCLUSIONS
  Introduction of an additional night shift to provide mandatory as opposed to on-demand 24-hour staff critical care specialist coverage did not affect long-term survival of medical ICU patients.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Rochester, MN 55905, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Reriani
authors.forename: Michelle
authors.initials: M
authors.lastname: Biehl
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Sloan
authors.forename: Michael
authors.initials: M
authors.lastname: Malinchoc
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
mesh_terms: D018806:APACHE; D000368:Aged; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D005260:Female; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008297:Male; D008511:Medicine / Q000458:organization & administration*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011788:Quality of Life