ArticleChest2015
Nighttime intensivist staffing, mortality, and limits on life support: a retrospective cohort study.
Article in Chest, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Limitation of Life-Sustaining Care in the Critically Ill: A Systematic Review of the Literature.Journal of hospital medicine · 2019Pooled it
- Temporal distribution of recorded intensive care unit deaths across the 24-hour cycle: a 15-year retrospective hospital-based study.BMC anesthesiology · 2026Observational
- The Case for Telemedicine-Enhanced Nighttime Staffing in a Neuro-ICU.Critical care explorations · 2025Article
- Impact of board-certified intensive care training facilities on choice of adjunctive therapies and prognosis of severe respiratory failure: a nationwide cohort study.Journal of intensive care · 2024Article
- SWEAT ICU-An Observational Study of Physician Workload and the Association of Physician Outcomes in Academic ICUs.Critical care explorations · 2022Article
- Examination of Impact of After-Hours Admissions on Hospital Resource Use, Patient Outcomes, and Costs.Critical care research and practice · 2022Article
- Sleep and Work in ICU Physicians During a Randomized Trial of Nighttime Intensivist Staffing.Critical care medicine · 2019Observational
- Patient Outcomes After the Introduction of Statewide ICU Nurse Staffing Regulations.Critical care medicine · 2018Article
- Accounting for Patient Preferences Regarding Life-Sustaining Treatment in Evaluations of Medical Effectiveness and Quality.American journal of respiratory and critical care medicine · 2017Article
- Simulation of a Novel Schedule for Intensivist Staffing to Improve Continuity of Patient Care and Reduce Physician Burnout.Critical care medicine · 2017Article
- Diffusion of Evidence-based Intensive Care Unit Organizational Practices. A State-Wide Analysis.Annals of the American Thoracic Society · 2017Article
- Nighttime physician staffing improves patient outcomes: no.Intensive care medicine · 2016Review
- Intensive Care Unit Structure Variation and Implications for Early Mobilization Practices. An International Survey.Annals of the American Thoracic Society · 2016Article
- Night shifts, human factors, and errors in the ICU: a causal pathway?Intensive care medicine · 2016Article
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Authors and funding
4 authors.
Funding
Abstract
backgroundEvidence regarding nighttime physician staffing of ICUs is suboptimal. We aimed to determine how nighttime physician staffing models influence patient outcomes.
methodsWe performed a multicenter retrospective cohort study in a multicenter registry of US ICUs. The exposure variable was the ICU's nighttime physician staffing model. The primary outcome was hospital mortality. Secondary outcomes included new limitations on life support, ICU length of stay, hospital length of stay, and duration of mechanical ventilation. Daytime physician staffing was studied as a potential effect modifier.
resultsThe study included 270,742 patients in 143 ICUs. Compared with nighttime staffing with an attending intensivist, nighttime staffing without an attending intensivist was not associated with hospital mortality (OR, 1.03; 95% CI, 0.92-1.15; P = .65). This relationship was not modified by daytime physician staffing (interaction P = .19). When nighttime staffing was subcategorized, neither attending nonintensivist nor physician trainee staffing was associated with hospital mortality compared with attending intensivist staffing. However, nighttime staffing without any physician was associated with reduced odds of hospital mortality (OR, 0.79; 95% CI, 0.68-0.91; P = .002) and new limitations on life support (OR, 0.83; 95% CI, 0.75-0.93; P = .001). Nighttime staffing was not associated with ICU or hospital length of stay. Nighttime staffing with an attending nonintensivist was associated with a slightly longer duration of mechanical ventilation (hazard ratio, 1.05; 95% CI, 1.02-1.09; P < .001).
conclusionsWe found little evidence that nighttime physician staffing models affect patient outcomes. ICUs without physicians at night may exhibit reduced hospital mortality that is possibly attributable to differences in end-of-life care practices.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.