CHEST Guidelines-Should-Quality-of-Care-Provided-by-Nighttime-Inten

Should-Quality-of-Care-Provided-by-Nighttime-Inten

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The correspondence section of the August 2015 issue of CHEST focuses on discussions about nighttime intensivist staffing in ICU settings. A retrospective study by Kerlin et al. suggested that nighttime intensivist coverage does not significantly impact patient mortality rates or lengths of stay, aligning with earlier research. Doctors Rho, Hompesch, and Patel from the University of Texas Southwestern Medical Center responded, suggesting that it is crucial to assess how such staffing affects the education and autonomy of medical trainees, as research indicates that constant supervision might lead to less trainee autonomy and potential over-reliance on guidance. They proposed further studies focusing on educational impacts, like procedural complication rates and the use of simulation-based testing, to ensure the maintenance of high-quality medical training under current duty hour regulations.<br /><br />Concurrently, Dr. Sriratanaviriyakul and Dr. Albertson questioned whether mortality is an adequate sole measure of the quality of care provided by intensivists. They highlighted that intensivists also have significant roles in establishing care goals with patients and families, potentially focusing on comfort over curative measures, which mortality alone may not capture. They also pointed out a counterintuitive finding in Kerlin's study, where ICUs without nighttime intensivists showed lower mortality, possibly due to different approaches to end-of-life care or ICU triage practices.<br /><br />Both responses emphasize that while mortality is a common outcome measure in ICU research, it may not fully encapsulate the roles and impacts of intensivists. They advocate for broader metrics of care quality and call for future research to include more comprehensive outcomes.

Keywords

nighttime intensivist staffing

ICU settings

patient mortality

medical trainees

education autonomy

care quality metrics

end-of-life care

ICU triage

procedural complication rates

simulation-based testing