title: Comparing mortality among adult, general intensive care units in England with varying intensivist cover patterns: a retrospective cohort study.
abstract: BACKGROUND
  Research has demonstrated that intensivist-led care of the critically ill is associated with reduced intensive care unit (ICU) and hospital mortality. The objective of this study was to evaluate whether a relation exists between intensivist cover pattern (for example, number of days of continuous cover) and patient outcomes among adult general ICUs in England.
  
  
  METHODS
  We conducted a retrospective cohort study by using data from a pooled case mix and outcome database of adult general critical care units participating in the Intensive Care National Audit & Research Centre (ICNARC) Case Mix Programme. Consecutive admissions to participating units for the years 2010 to 2011 were linked to a survey of intensivist cover practices. Our primary outcome of interest was mortality at ultimate discharge from acute-care hospital.
  
  
  RESULTS
  The analysis included 80,122 patients admitted to 130 ICUs in 128 hospitals. Multivariable logistic regression analysis was used to assess the relation between intensivist cover patterns (days of continuous cover, grade of physician staffing at nighttime, and frequency of daily handovers) and acute hospital mortality, adjusting for patient case mix. No relation was seen between days of continuous cover by a single intensivist or grade of physician staffing at nighttime and acute hospital mortality. Acute hospital mortality and ICU length of stay were not associated with intensivist characteristics, intensivist full-time equivalents per bed, or years of clinical experience. Intensivist participation in handover was associated with increased mortality (odds ratio, 1.27; 95% confidence interval, 1.04 to 1.55); however, only nine units reported no intensivist participation.
  
  
  CONCLUSIONS
  We found no relation between days of continuous cover by a single intensivist or grade of physician staffing at nighttime and patient outcomes in adult, general ICUs in England. Intensivist participation in handover was associated with increased mortality; further research to confirm or refute this finding is required.
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Wilcox
authors.forename: David A
authors.initials: DA
authors.lastname: Harrison
authors.forename: Alasdair
authors.initials: A
authors.lastname: Short
authors.forename: Max
authors.initials: M
authors.lastname: Jonas
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Rowan
mesh_terms: D000328:Adult; D054869:Clinical Audit; D016638:Critical Illness / Q000401:mortality*; D003953:Diagnosis-Related Groups; D004739:England / Q000453:epidemiology; D019538:Health Care Surveys; D006742:Hospital Bed Capacity; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008505:Medical Staff, Hospital / Q000145:classification* / Q000458:organization & administration / Q000706:statistics & numerical data; D009551:Night Care / Q000458:organization & administration / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling; D012044:Regression Analysis; D012189:Retrospective Studies; D000078329:Workforce