CHEST Guidelines-Response_chest

Response_chest_19

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The correspondence in the journal addresses critiques and discussions from Drs. Sriratanaviriyakul, Albertson, and Rho, alongside colleagues, concerning a study on nighttime intensivist staffing in Intensive Care Units (ICU). The original study highlighted mortality limitations as a primary outcome measure, acknowledging its methodological and conceptual drawbacks in critical care research. The authors agree mortality alone isn’t an adequate indicator of ICU care quality because it doesn't consider the broader role of intensivists, such as establishing care goals with patients and families or managing end-of-life care.<br /><br />A significant observation from Dr. Kerlin and colleagues' study indicated that ICUs without nighttime physicians were associated with lower mortality, a finding attributed to differences in end-of-life care management and staffing models. This highlights that the approach to nighttime staffing in ICUs might differ, impacting mortality rates. They note the importance of reevaluating how mortality outcomes are interpreted in intensive care settings and pushing for additional research to unpack this complex issue.<br /><br />Additionally, Rho and colleagues stress the educational impact of nighttime staffing, which might shape the preparedness of future ICU physicians. Currently, educational outcomes mainly focus on perceptions of education and autonomy, which don't necessarily align with actual competency. The evolving staffing patterns indicate a need for further investigation into educational impacts to ensure the competency and effective training of future intensivists.<br /><br />The conversation underscores the need for future studies to explore a broader array of clinical outcomes and probe deeper into educational impacts to understand the true efficacy of nighttime intensivist staffing, beyond mere mortality rates. The discourse reinforces the necessity of an integrated approach that considers multiple outcome measures for an accurate portrayal of ICU effectiveness and quality care.

Keywords

nighttime intensivist staffing

ICU mortality

end-of-life care

staffing models

intensive care research

clinical outcomes

educational impacts

ICU care quality

future intensivists

critical care