Pediatrics |

A National Survey of Pediatric Intensivists Regarding 24/7 In-House Attending Coverage FREE TO VIEW

Kyle Rehder, MD; Ira Cheifetz, MD; David Turner, MD
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Duke Children's Hospital, Durham, NC

Chest. 2013;144(4_MeetingAbstracts):766A. doi:10.1378/chest.1702306
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SESSION TITLE: Pediatric Critical Care

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 30, 2013 at 07:30 AM - 09:00 AM

PURPOSE: The need for continuous in-house intensivist coverage is debated within the critical care community. Proponents of 24/7 in-house critical care attending (IHA) models suggest that increased intensivist presence improves patient outcomes. However, data regarding the impact of IHA coverage on outcomes in pediatric critical care are limited, and no data exist regarding the effects of IHA on faculty. We hypothesized that pediatric intensivists in IHA models experience higher rates of burnout and perceive decreased academic productivity.

METHODS: A national web-based survey was distributed to attending pediatric intensivists at academic centers. Questions focused on the demographics and effects of IHA models, including patient care and physician burnout.

RESULTS: 472 intensivists responded from 147 centers (50% center response rate). 53% of intensivists work in an IHA model, 26% a home coverage model, and 21% a mixed model. Intensivists working in IHA models were more likely to state that IHA models are good for patient care (91% vs. 74% p<0.0001) and less likely to perceive that IHA coverage has a negative impact on either non-clinical responsibilities (60% vs. 71% p=0.04) or their families (47% vs. 59% p=0.04). While 56% of intensivists state that IHA models increase burnout risk, no difference was noted in burnout scores between intensivists in IHA models and home models. 76% of intensivists prefer their current work model, while 60% of intensivists with experience in both models prefer IHA coverage. Of 7 centers that measured pre- and post-IHA outcomes, 4 reported patient benefit, while 3 reported no change. 26% of intensivists receive supplemental pay for IHA coverage, at a median rate of $100/hr.

CONCLUSIONS: 24/7 IHA coverage in pediatrics ICUs is common, yet the benefit to patients remains unclear. While intensivists in home coverage models predict that IHA coverage models would negatively impact lifestyle, intensivists in IHA models do not report higher levels of burnout or negative impact on academic productivity or family life.

CLINICAL IMPLICATIONS: 24/7 in house pediatric intensivist coverage models are highly variable among academic centers.

DISCLOSURE: The following authors have nothing to disclose: Kyle Rehder, Ira Cheifetz, David Turner

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