We intensivists are so darned important and valuable (just ask us). Many say the more we’re around, the more lives are saved, especially at night. But there’s an inherent tension between the benefits of having us in the ICU all the time, and the risks of us burning out, cashing in our 401(k) and running off to Aruba with the cute respiratory therapist from 5G.
Ali et al asked whether different work schedules impacted patient outcomes or intensivist job satisfaction. In 5 academic MICUs (45 intensivists, 1,900 patients), they cluster-randomized the centers to schedule their intensivists to work either 2 weeks continuously (“continuous”), or 2 weeks with their weekends cross-covered by other intensivists (“interrupted”). They collected data for 9 months prospectively.
Two ICUs backing out (of an original planned 7) reduced their overall sample size to 44% of what was planned. The dropouts further introduced imbalances in the clustering, such that all but one ICU ended up doing the more pleasant interrupted schedule twice as often as the weekend-busting continuous schedule. So they also got less data from the continuous schedule than they originally intended.
Physicians’ group assignment was not blinded (obviously), and let’s be honest — everyone has a vested interest in the study results, whose outcomes could easily be inferred by the surveys. It would be easy to “game” the surveys, intentionally or unconsciously: if you preferred the interrupted schedule, you might exaggerate your “burnout” during the continuous phase, your happiness during the interrupted phase, or only respond after one.
Having said all that, there was no difference in ICU length of stay or mortality between the (underpowered) groups. However, physicians working the interrupted schedule reported significantly less burnout, work-home life imbalance, and job distress than those working the continuous schedule.
To which I say two things: “Duh,” and “Thanks!” We all want our weekends off, and of course we would be happier that way if it means no one gets hurt. I’m openly gleeful for this evidence that could support doctor-friendly scheduling. Authors also helpfully point out that the scant “evidence” on negative effects of handoffs & discontinuity of care only analyzed surrogate outcomes, and didn’t study ICU care.
Just one question though: Who will work the weekends, and how do they feel about it? (This is a zero-sum game, after all …)
Ali NA et al. Continuity of Care in Intensive Care Units: A Cluster-Randomized Trial of Intensivist Staffing. Am J Respir Crit Care Med 2011;184:803-808.