Table 4.
Odds Ratio for Death in ICUs with Nighttime Intensivist Staffing in the APACHE and PHC4 Cohorts.*
| Cohort | No. of Patients | Low-Intensity Daytime Staffing | High-Intensity Daytime Staffing | Interaction Term | ||
|---|---|---|---|---|---|---|
| Odds Ratio (95% CI) | P Value | Odds Ratio (95% CI) | P Value | P Value | ||
| APACHE† | 65,752 | 0.62 (0.39–0.97) | 0.04 | 1.08 (0.63–1.84) | 0.78 | 0.02 |
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| Patients with active treatment on admission | 44,420 | 0.59 (0.36–0.97) | 0.04 | 1.15 (0.71–1.88) | 0.57 | <0.01 |
|
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| Patients who underwent mechanical ventilation‡ | 29,498 | 0.60 (0.37–0.96) | 0.03 | 1.36 (0.86–2.15) | 0.19 | <0.01 |
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| Patients admitted at night§ | 29,088 | 0.51 (0.32–0.82) | 0.01 | 1.01 (0.71–1.44) | 0.95 | <0.01 |
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| Patients in highest third of acute physiology scores | 21,532 | 0.56 (0.38–0.82) | <0.01 | 1.16 (0.75–1.79) | 0.51 | <0.01 |
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| Patients with sepsis¶ | 5,816 | 0.46 (0.29–0.74) | <0.01 | 0.88 (0.58–1.33) | 0.54 | <0.01 |
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| Alternative definition of nighttime staffing: nighttime intensivist or resident physician | 65,752 | 0.42 (0.29–0.59) | <0.01 | 0.47 (0.34–0.65) | <0.01 | <0.01 |
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| PHC4 cohort∥ | 107,319 | 0.83 (0.69–0.99) | 0.049 | 0.97 (0.67–1.39) | 0.86 | 0.18 |
APACHE denotes Acute Physiology and Chronic Evaluation, and PHC4 Pennsylvania Health Care Cost Containment Council.
Odds ratios and 95% confidence intervals compare nighttime intensivist staffing in the ICU with any other nighttime staffing. Models were adjusted for age, sex, race or ethnic group, acute physiology score, presence or absence of chronic coexisting conditions, preadmission location of the patient, diagnosis, type of ICU, daytime intensivist staffing model, annualized ICU volume of admissions, and use or nonuse of mechanical ventilation on the day of admission. Confidence intervals take into account clustering at the ICU level.
Active treatment was defined as any of 33 active life-supporting intensive care treatments.14
Nighttime admission was defined as admission between 7 p.m. and 7 a.m.
The primary admission diagnosis of sepsis was determined by the admitting clinicians.
Odds ratios and 95% confidence intervals are for nighttime intensivist staffing in the ICU with any other nighttime staffing. Models were adjusted for age, sex, race, predicted probability of death, presence or absence of chronic coexisting conditions, teaching status of the hospital, type of ICU, daytime intensivist staffing model, and annualized ICU volume of admissions. Confidence intervals take into account clustering at the ICU level.