title: ICU physician-based determinants of life-sustaining therapy during nights and weekends: French multicenter study from the Outcomerea Research Group.
abstract: OBJECTIVE
  Patient- and organization-related factors are the most common influences affecting the ICU decision-making process. Few studies have investigated ICU physician-related factors and life-sustaining treatment use during nights and weekends, when staffing ratios are low. Here, we described patients admitted during nights/weekends and looked for physician-related determinants of life-sustaining treatment use in these patients after adjustment for patient- and center-related factors.
  
  
  METHODS
  Multicenter observational cohort study of admission procedures during nights/weekends shifts.
  
  
  METHODS
  ICU physicians working nights/weekends in 6 French ICUs.
  
  
  METHODS
  None.
  
  
  RESULTS
  Patient characteristics and intensity of care were extracted from the prospective Outcomerea database. Physician characteristics were age, gender, religion and religiosity, ICU experience, specialty, being a permanent ICU staff member, degree in ethics, and degree in intensive care. We used hierarchical mixed models to adjust on center, physician random effects, and admission patient characteristics. Of 156 physicians contacted, 119 (77%) participated. Patients admitted during nights/weekends were younger and had fewer comorbidities and lower treatment intensity during the shift. ICU physicians who are younger than 35 years used more renal replacement therapy (odds ratio, 1.04; 95% CI, 1-1.07; p = 0.04), invasive mechanical ventilation (odds ratio, 1.09; 95% CI, 1.1-1.19; p = 0.04), and vasopressors (odds ratio, 1.16; 95% CI, 1.09-1.23; p < 0.0001). Internal or emergency medicine as the primary specialty was associated with invasive mechanical ventilation (odds ratio, 1.14; 95% CI, 1.04-1.24; p = 0.004) and vasopressor use (odds ratio, 1.09; 95% CI, 1.02-1.17; p = 0.01). Noninvasive ventilation was used less often by physicians with more than 10 years of night/weekend shifts and more often by those with religious beliefs (odds ratio, 1.05; 95% CI, 1.01-1.08; p = 0.008).
  
  
  CONCLUSIONS
  Patients admitted during nights/weekends were younger and had fewer comorbidities. Age, specialty, ICU experience, and religious beliefs of the physicians were significantly associated life-sustaining treatments used.
authors.affiliation: 1Medical-Surgical ICU, Saint Joseph Hospital Network, Paris, France. 2Infection, Antimicrobials, Modelling, Evolution, UMR 1137, Inserm and Paris Diderot University, Paris, France. 3Department of Biostatistics-HUPNVS-AP-HP, UFR de Médecine-Bichat, Paris, France. 4Medical ICU, Saint Etienne University Hospital, Saint-Priest en Jarez, France. 5University Joseph Fourier, Integrated Research Center U823 "Epidemiology of Cancers and Severe Diseases," Albert Bonniot Institute, La Tronche Cedex, France. 6Department of Biostatistics, Outcomerea, Bobigny, France. 7Medical-Surgical ICU, Avicenne University Hospital, Bobigny, France. 8Department of Physiology, Cochin University Hospital, Paris, France. 9Medical ICU, Grenoble University, Albert Michallon University Hospital, Grenoble France. 10Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia. 11Burns, Trauma and Critical Care Research Centre, University of Brisbane, St. Lucia, Australia. 12Medical and Infectious ICU, Bichat Claude Bernard Hospital, University Paris Diderot, Paris, France.
authors.forename: Maïté
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.forename: Mouna
authors.initials: M
authors.lastname: Ben-Rehouma
authors.forename: Michael
authors.initials: M
authors.lastname: Darmon
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ruckly
authors.forename: Christophe
authors.initials: C
authors.lastname: Clec'h
authors.forename: Christophe
authors.initials: C
authors.lastname: Adrie
authors.forename: Alexis
authors.initials: A
authors.lastname: Tabah
authors.forename: Aurélien
authors.initials: A
authors.lastname: Vesin
authors.forename: Carole
authors.initials: C
authors.lastname: Schwebel
authors.forename: Benoit
authors.initials: B
authors.lastname: Misset
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Timsit
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000379:methods*; D000368:Aged; D001071:Appointments and Schedules; D001291:Attitude of Health Personnel; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D016208:Databases, Factual; D003657:Decision Making; D005260:Female; D005602:France; D006801:Humans; D007362:Intensive Care Units; D008020:Life Support Care / Q000592:standards* / Q000639:trends; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D011446:Prospective Studies