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Original Research |

24/7 In-house Intensivist Coverage and Fellowship Education24/7 In-house Intensivist Survey: A Cross-sectional Survey of Academic Medical Centers in the United States

Enrique Diaz-Guzman, MD; Colleen Y. Colbert, PhD; David M. Mannino, MD, FCCP; Daniel L. Davenport, PhD; Alejandro C. Arroliga, MD, FCCP
Author and Funding Information

From the Department of Pulmonary and Critical Care (Dr Diaz-Guzman), and the Department of Surgery (Dr Davenport), University of Kentucky, Lexington, KY; the Department of Medicine (Drs Colbert and Arroliga), Scott & White/Texas A&M HSC College of Medicine, Temple, TX; and the University of Kentucky College of Public Health (Dr Mannino), Lexington, KY.

Correspondence to: Enrique Diaz-Guzman, MD, University of Kentucky, 740 S Limestone St, L543 Kentucky Clinic, Lexington, KY 40536-0284; e-mail: enriquedgz@uky.edu


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Funding/Support: The authors have reported to CHEST that no funding was received for this study.


© 2012 American College of Chest Physicians


Chest. 2012;141(4):959-966. doi:10.1378/chest.11-2073
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Objectives:  The objectives of this study were to determine the current staffing models of practice and the frequency of 24/7 coverage in academic medical centers in the United States and to assess the perceptions of critical care trainees and program directors toward these models.

Methods:  A cross-sectional national survey was conducted using an Internet-based survey platform. The survey was distributed to fellows and program directors of 374 critical care training programs in US academic medical centers.

Results:  We received 518 responses: 138 from program directors (PDs) (37% of 374 programs) and 380 fellow responses. Coverage by a board-certified or board-eligible intensivist physician 24/7 was reported by 33% of PD respondents and was more common among pediatric and surgical critical care programs. Mandatory in-house call for critical care trainees was reported by 48% of the PDs. Mandatory call was also more common among pediatric-critical care programs compared with the rest (P < .001). Advanced nurse practitioners with critical care training were reported available by 27% of the PDs. The majority of respondents believed that 24/7 coverage would be associated with better patient care in the ICU and improved education for the fellows, although 65% of them believed this model would have a negative impact on trainees’ autonomy.

Conclusions:  Intensivist coverage 24/7 was not commonly used in US academic centers responding to our survey. Significant differences in coverage models among critical care medicine specialties appear to exist. Program director and trainee respondents believed that 24/7 coverage was associated with better outcomes and education but also expressed concerns about the impact of this model on fellows’ autonomy.

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