Overnight staffing in Canadian neonatal and pediatric intensive care units.

Infants and children who require specialized medical attention are admitted to neonatal and pediatric intensive care units (ICUs) for continuous and closely supervised care. Overnight in-house physician coverage is frequently considered the ideal staffing model. It remains unclear how often this is achieved in both pediatric and neonatal ICUs in Canada. The aim of this study is to describe overnight in-house physician staffing in Canadian pediatric and level-3 neonatal ICUs (NICUs) in the pre-COVID-19 era. A national cross-sectional survey was conducted in 34 NICUs and 19 pediatric ICUs (PICUs). ICU directors or their delegates completed a 29-question survey describing overnight staffing by resident physicians, fellow physicians, nurse practitioners, and attending physicians. A comparative analysis was conducted between ICUs with and without in-house physicians. We obtained responses from all 34 NICUs and 19 PICUs included in this study. A total of 44 ICUs (83%) with in-house overnight physician coverage provided advanced technologies, such as extracorporeal life support, and included all ICUs that catered to patients with cardiac, transplant, or trauma conditions. Residents provided the majority of overnight coverage, followed by the Critical Care Medicine fellows. An attending physician was in-house overnight in eight (15%) out of the 53 ICUs, seven of which were NICUs. Residents participating in rotations in the ICU would often have rotation durations of less than 6 weeks and were often responsible for providing care during shifts lasting 20-24 h. Most PICUs and level-3 NICUs in Canada have a dedicated in-house physician overnight. These physicians are mainly residents or fellows, but a notable variation exists in this arrangement. The potential effects on patient outcomes, resident learning, and physician satisfaction remain unclear and warrant further investigation.

Maratta C ，Hutchison K ，Nicoll J ，Bagshaw SM ，Granton J ，Kirpalani H ，Stelfox HT ，Ferguson N ，Cook D ，Parshuram CS ，Moore GP ... -  《Frontiers in Pediatrics》

In-house, overnight physician staffing: a cross-sectional survey of Canadian adult and pediatric intensive care units.

Parshuram CS ，Kirpalani H ，Mehta S ，Granton J ，Cook D ，Canadian Critical Care Trials Group ... -  《CRITICAL CARE MEDICINE》

In-House, Overnight Physician Staffing: A Cross-Sectional Survey of Canadian Adult ICUs.

Maratta C ，Hutchison K ，Moore GP ，Bagshaw SM ，Granton J ，Kirpalani H ，Stelfox HT ，Ferguson N ，Cook D ，Parshuram CS ... -  《-》

A Prospective Trial of an In-house Overnight Fellow Rotation in the Intensive Care Unit.

Although previous studies in academic intensive care units (ICUs) have found no improvement in patient care outcomes with in-house overnight attending physician coverage compared with home call coverage, the effect of in-house supervision on trainee education and well-being is less clear. In addition, no studies have examined the effect of in-house coverage by fellow physicians overnight. What is the impact of an in-house overnight critical care fellow on resident, fellow, and attending perception of patient safety, house staff education, and house staff well-being? A prospective trial alternating 2-week periods of in-house overnight critical care fellow coverage with 2-week periods of home call coverage was performed in our tertiary medical ICU. Residents, fellows, and attendings were surveyed to evaluate perceptions of the night fellows' impact on patient care, communication, supervision, educational experience, autonomy, well-being, and job satisfaction. Over the 6-month study period, surveys were sent to 83 residents, 22 fellows, and 23 attendings, with completion by 56 (67%), 22 (100%), and 16 (70%), respectively. Overall, 89% of residents, 68% of fellows, and 81% of attendings reported perceived improvements in patient care with an in-house fellow. The in-house fellow was also associated with improved well-being in 79% of residents and 73% of fellows, and 82% of residents felt that it positively impacted education. As compared with the traditional home call system, an in-house night critical care fellow can improve the perception of patient care, trainee well-being, and education in a tertiary ICU at an academic hospital.

Schwab Jensen K ，Sherman AE ，Wang T ，Melamed K ... -  《-》

Pediatric Cardiac Intensive Care Distribution, Service Delivery, and Staffing in the United States in 2018.

Horak RV ，Alexander PM ，Amirnovin R ，Klein MJ ，Bronicki RA ，Markovitz BP ，McBride ME ，Randolph AG ，Thiagarajan RR ... -  《Pediatric Critical Care Medicine》