title: The relationship between in-house attending coverage and nighttime extubation following congenital heart surgery*.
abstract: OBJECTIVE
  Many cardiac ICUs have instituted 24/7 attending physician in-house coverage, which theoretically may allow for more expeditious weaning from ventilation and extubation. We aimed to determine whether this staffing strategy impacts rates of nighttime extubation and duration of mechanical ventilation.
  
  
  METHODS
  National data were obtained from the Virtual PICU System database for all patients admitted to the cardiac ICU following congenital heart surgery in 2011 who required postoperative mechanical ventilation. Contemporaneous data from our local institution were collected in addition to the Virtual PICU System data. The combined dataset (n = 2,429) was divided based on the type of nighttime staffing model in order to compare rates of nighttime extubation and duration of mechanical ventilation between units that used an in-house attending staffing strategy and those that employed nighttime residents, fellows, or midlevel providers only.
  
  
  RESULTS
  Institutions that currently use 24/7 in-house attending coverage did not demonstrate statistically significant differences in rates of nighttime extubation or the duration of mechanical ventilation in comparison to units without in-house attendings. Younger patients cared for in non-in-house attending units were more likely to require reintubation.
  
  
  CONCLUSIONS
  Pediatric patients who have undergone congenital heart surgery can be safely and effectively extubated without the routine presence of an attending physician. The utilization of nighttime in-house attending coverage does not appear to have significant benefits on the rate of nighttime extubation and may not reduce the duration of mechanical ventilation in units that already use in-house residents, fellows, or other midlevel providers.
authors.affiliation: 1Sibley Heart Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA. 2Department of Pediatric Cardiology, Emory University, Atlanta, GA. 3Department of Pediatrics, Emory University, Atlanta, GA. 4Department of Cardiothoracic Surgery, Emory University, Atlanta, GA.
authors.forename: Glen J
authors.initials: GJ
authors.lastname: Iannucci
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Oster
authors.forename: Nikhil K
authors.initials: NK
authors.lastname: Chanani
authors.forename: Scott E
authors.initials: SE
authors.lastname: Gillespie
authors.forename: Courtney E
authors.initials: CE
authors.lastname: McCracken
authors.forename: Kirk R
authors.initials: KR
authors.lastname: Kanter
authors.forename: William T
authors.initials: WT
authors.lastname: Mahle
mesh_terms: D060666:Airway Extubation / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures; D002648:Child; D002675:Child, Preschool; D005845:Georgia; D006330:Heart Defects, Congenital / Q000601:surgery* / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008505:Medical Staff, Hospital / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data*; D010820:Physicians; D011184:Postoperative Period; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D000078329:Workforce