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Survey of In-House Coverage by Pediatric Intensivists

Characterization of 24/7 In-Hospital Pediatric Critical Care Faculty Coverage*

Rehder, Kyle J. MD1; Cheifetz, Ira M. MD, FCCM1; Markovitz, Barry P. MD, MPH2; Turner, David A. MD1 for the Pediatric Acute Lung Injury and Sepsis Investigators Network

Pediatric Critical Care Medicine: February 2014 - Volume 15 - Issue 2 - p 97–104
doi: 10.1097/PCC.0000000000000032
Feature Articles

Objective: To characterize the current state of 24/7 in-hospital pediatric intensivist coverage in academic PICUs, including perceptions of faculty and trainees regarding the advantages and disadvantages of in-hospital coverage.

Design: Cross-sectional observational study via web-based survey.

Setting: PICUs at North American academic institutions.

Subjects: Pediatric intensivists, pediatric critical care fellows, and pediatric residents.

Interventions: None.

Measurements and Main Results: A total of 1,323 responses were received representing a center response rate of 74% (147 of 200). Ninety percent of respondents stated that in-hospital coverage is good for patient care, and 85% stated that in-hospital coverage provides safer care. Sixty-three percent of intensivists stated that working in in-hospital models limits academic productivity, and 65% stated that in-hospital models interfere with nonclinical responsibilities. When compared with intensivists in home coverage models, intensivists working in in-hospital models generally had more favorable perceptions of the effects of in-hospital on patient care (p < 0.0001) and faculty quality of life. Physician burnout was measured with the abbreviated Maslach Burnout Inventory. Although 57% of intensivists responded that working in in-hospital models increases burnout risk, burnout scores were not different between coverage models. Seventy-nine percent of intensivists currently working at institutions with in-hospital coverage stated that they would prefer to work in an in-hospital coverage model, compared with 31% of those working in a home coverage model (p < 0.0001).

Conclusions: Although concerns exist regarding the effect of 24/7 in-hospital coverage on faculty, the majority of pediatric intensivists and critical care trainees responded that in-hospital coverage by intensivists is good for patient care. The majority of intensivists also state that they would prefer to work at an institution with in-hospital coverage. Further research is needed to objectively delineate the effects of in-hospital coverage on both patients and faculty.

1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children’s Hospital, Duke University Medical Center, Durham, NC.

2Division of Critical Care Medicine, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA.

* See also p. 170.

This study was performed at Duke University Medical Center.

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Dr. Cheifetz consulted for Philips, Hill-Rom, Discovery Labs, and Teleflex and provided expert testimony for various entities. His institution received grant support from CareFusion, Philips, Teleflex, and Covidien. Authors have disclosed that they do not have any potential conflicts of interest.

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©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies