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Editorials |

A Shift for the Better

Craig M. Lilly, MD; Christopher P. Landrigan, MD, MPH
Author and Funding Information

Affiliations: Boston, MA
 ,  Drs. Lilly and Landrigan are affiliated with Brigham and Women’s Hospital.

Correspondence to: Craig M. Lilly, MD, Brigham and Women’s Hospital, Boston, MA 02215; e-mail: clilly@partners.org



Chest. 2005;128(6):3787-3788. doi:10.1378/chest.128.6.3787
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One of the most pressing questions facing the critical care community is how best to staff our ICUs. Adequate staffing is associated with reduced mortality (relative risk for ICU mortality, 0.61; 95% confidence interval, 0.50 to 0.75) and shorter length of critical illness,1 yet it has been clear for some time that we are facing a growing shortage of physicians to staff our units.2 Unlike specialties such as emergency medicine, which have adopted work duration limits and consequent transferral of patient management among rested physicians, the approach in most ICUs is either not to provide continuous on-site physician care or to have physicians-in-training work frequent extended-duration shifts (> 24 h).

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