title: Twenty-four-hour intensivist presence: a pilot study of effects on intensive care unit patients, families, doctors, and nurses.
abstract: BACKGROUND
  Around-the-clock intensivist presence in intensive care units (ICUs) has been promoted as necessary to optimize outcomes. Little data have addressed how it affects the multiple stakeholders in such care.
  
  
  OBJECTIVE
  To assess effects of around-the-clock intensivist presence on intensivists, patients, families, housestaff, and nurses.
  
  
  METHODS
  This 32-week, crossover pilot trial of two intensivist staffing models, performed in two Canadian ICUs, alternated 8-week blocks of two staffing models: the standard model, where one intensivist worked for 7 days, taking night call from home; and the shift work model, where one intensivist worked 7 day shifts, while other intensivists remained in the ICU at night.
  
  
  RESULTS
  Surveys scaled from 0-100 points assessed outcomes for 24 intensivists (primary outcome: burnout); 119 families (satisfaction); 74 nurses (satisfaction with collaboration and communications, role conflict); and 34 housestaff (autonomy, supervision, and learning opportunities). Outcomes for 501 patients included mortality, length of stay, and resource use. Intensivists doing shift work experienced less burnout (-6.9 points; P = 0.04). Adjusted hospital mortality (odds ratio, 1.22; P = 0.44), ICU length of stay (-6 h; P = 0.46), and family satisfaction (0.9 points; P = 0.79) did not differ between staffing models. Under shift work staffing, nurses reported more role conflict (9 points; P < 0.001), whereas nighttime housestaff reported less autonomy, more supervision, but no difference in learning opportunities.
  
  
  CONCLUSIONS
  Shiftwork staffing was better for intensivists and most were receptive once they had experienced it. Although there were no evident negative outcomes for patients or families, further evaluation is needed to clarify how around-the-clock intensivist staffing influences the various stakeholders in ICU care, given power considerations in this study. Clinical trial registered with www.clinicaltrials.gov (NCT 01146691).
authors.affiliation: Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. agarland@hsc.mb.ca
authors.forename: Allan
authors.initials: A
authors.lastname: Garland
authors.forename: Dan
authors.initials: D
authors.lastname: Roberts
authors.forename: Lesley
authors.initials: L
authors.lastname: Graff
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003258:Consumer Behavior; D003422:Critical Care / Q000379:methods; D018592:Cross-Over Studies; D005190:Family; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009726:Nurses; D017063:Outcome Assessment, Health Care; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D010865:Pilot Projects; D000078329:Workforce