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Critical Care Management| May 01 2017

Nurses’ Perceptions of In-Hospital Versus Telephone Availability of an Intensivist at Night in an Intensive Care Unit

Emily S. Stanton, MD, MSCE;

Emily S. Stanton, MD, MSCE

Emily S. Stanton was a pulmonary and critical care fellow at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, and is now an attending physician at Kaiser Permanente, Lafayette, Colorado. Cary Hilbert was a research coordinator at Perelman School of Medicine at the University of Pennsylvania, and is now an epidemiologist at the Centers for Disease Control and Prevention, Atlanta, Georgia. Stephanie Maillie is a clinical nurse specialist at the Hospital of the University of Pennsylvania. C. Jessica Dine is an assistant professor, Scott D. Halpern is an associate professor, and Meeta Prasad Kerlin is an assistant professor, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania. Halpern is director and Kerlin is faculty at the Palliative and Acute Illness Research (PAIR) Center; Halpern is director of the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program; and Dine, Halpern, and Kerlin are senior fellows of the Leonard Davis Institute of Health Economics of the University of Pennsylvania.

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Cary Hilbert, BS;

Cary Hilbert, BS

Emily S. Stanton was a pulmonary and critical care fellow at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, and is now an attending physician at Kaiser Permanente, Lafayette, Colorado. Cary Hilbert was a research coordinator at Perelman School of Medicine at the University of Pennsylvania, and is now an epidemiologist at the Centers for Disease Control and Prevention, Atlanta, Georgia. Stephanie Maillie is a clinical nurse specialist at the Hospital of the University of Pennsylvania. C. Jessica Dine is an assistant professor, Scott D. Halpern is an associate professor, and Meeta Prasad Kerlin is an assistant professor, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania. Halpern is director and Kerlin is faculty at the Palliative and Acute Illness Research (PAIR) Center; Halpern is director of the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program; and Dine, Halpern, and Kerlin are senior fellows of the Leonard Davis Institute of Health Economics of the University of Pennsylvania.

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Stephanie Maillie, RN, MSN, CCNS;

Stephanie Maillie, RN, MSN, CCNS

Emily S. Stanton was a pulmonary and critical care fellow at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, and is now an attending physician at Kaiser Permanente, Lafayette, Colorado. Cary Hilbert was a research coordinator at Perelman School of Medicine at the University of Pennsylvania, and is now an epidemiologist at the Centers for Disease Control and Prevention, Atlanta, Georgia. Stephanie Maillie is a clinical nurse specialist at the Hospital of the University of Pennsylvania. C. Jessica Dine is an assistant professor, Scott D. Halpern is an associate professor, and Meeta Prasad Kerlin is an assistant professor, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania. Halpern is director and Kerlin is faculty at the Palliative and Acute Illness Research (PAIR) Center; Halpern is director of the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program; and Dine, Halpern, and Kerlin are senior fellows of the Leonard Davis Institute of Health Economics of the University of Pennsylvania.

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C. Jessica Dine, MD;

C. Jessica Dine, MD

Emily S. Stanton was a pulmonary and critical care fellow at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, and is now an attending physician at Kaiser Permanente, Lafayette, Colorado. Cary Hilbert was a research coordinator at Perelman School of Medicine at the University of Pennsylvania, and is now an epidemiologist at the Centers for Disease Control and Prevention, Atlanta, Georgia. Stephanie Maillie is a clinical nurse specialist at the Hospital of the University of Pennsylvania. C. Jessica Dine is an assistant professor, Scott D. Halpern is an associate professor, and Meeta Prasad Kerlin is an assistant professor, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania. Halpern is director and Kerlin is faculty at the Palliative and Acute Illness Research (PAIR) Center; Halpern is director of the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program; and Dine, Halpern, and Kerlin are senior fellows of the Leonard Davis Institute of Health Economics of the University of Pennsylvania.

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Scott D. Halpern, MD, PhD;

Scott D. Halpern, MD, PhD

Emily S. Stanton was a pulmonary and critical care fellow at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, and is now an attending physician at Kaiser Permanente, Lafayette, Colorado. Cary Hilbert was a research coordinator at Perelman School of Medicine at the University of Pennsylvania, and is now an epidemiologist at the Centers for Disease Control and Prevention, Atlanta, Georgia. Stephanie Maillie is a clinical nurse specialist at the Hospital of the University of Pennsylvania. C. Jessica Dine is an assistant professor, Scott D. Halpern is an associate professor, and Meeta Prasad Kerlin is an assistant professor, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania. Halpern is director and Kerlin is faculty at the Palliative and Acute Illness Research (PAIR) Center; Halpern is director of the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program; and Dine, Halpern, and Kerlin are senior fellows of the Leonard Davis Institute of Health Economics of the University of Pennsylvania.

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Meeta Prasad Kerlin, MD, MSCE

Meeta Prasad Kerlin, MD, MSCE

Emily S. Stanton was a pulmonary and critical care fellow at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, and is now an attending physician at Kaiser Permanente, Lafayette, Colorado. Cary Hilbert was a research coordinator at Perelman School of Medicine at the University of Pennsylvania, and is now an epidemiologist at the Centers for Disease Control and Prevention, Atlanta, Georgia. Stephanie Maillie is a clinical nurse specialist at the Hospital of the University of Pennsylvania. C. Jessica Dine is an assistant professor, Scott D. Halpern is an associate professor, and Meeta Prasad Kerlin is an assistant professor, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania. Halpern is director and Kerlin is faculty at the Palliative and Acute Illness Research (PAIR) Center; Halpern is director of the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program; and Dine, Halpern, and Kerlin are senior fellows of the Leonard Davis Institute of Health Economics of the University of Pennsylvania.

Corresponding author: Meeta Prasad Kerlin, md, msce, The Perelman School of Medicine at the University of Pennsylvania, 3600 Spruce St, 05011 Gates Bldg, Philadelphia, PA 19104 (e-mail: prasadm@uphs.upenn.edu).

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Am J Crit Care (2017) 26 (3): 203–209.

https://doi.org/10.4037/ajcc2017338

Background

Evidence suggests that in-person management by nighttime intensivists does not change patients’ mortality rates in high-intensity intensive care units.

Objective

To better understand domains affected by nighttime intensivist staffing not previously measured.

Methods

Semistructured interviews of 13 night-shift nurses in an academic medical intensive care unit to elicit perceptions of nighttime staffing with attending intensivists versus residents with attending intensivists on call remotely. Interviews were done during the final months of a randomized trial comparing the same staffing models. Qualitative analysis was done by using a grounded theory approach. Three investigators independently reviewed interview transcripts to identify key domains.

Results

In addition to 5 themes probed during interviews (efficiency, communication, job place comfort, quality of patient care, and procedures), participants identified 3 other themes (supervision, systems issues, and experience). Most participants thought that nighttime intensivists improved clinical care, procedures, efficiency, communication, and job place comfort. Two thought that the quality of patient care, efficiency, or communication was the same with both arrangements. Three reported no effect on their job place comfort. Twelve mentioned improved supervision of trainees, and all thought systems issues improved.

Conclusions

Nurses perceive improvements with nighttime intensivists in several domains. Future work is needed to determine whether such perceptions translate into improved outcomes for staff or patients.

©2017 American Association of Critical-Care Nurses

2017

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