• Emily S Stanton, Cary Hilbert, Stephanie Maillie, C Jessica Dine, Scott D Halpern, and Meeta Prasad Kerlin.
• Emily S. Stanton was a pulmonary and critical care fellow at the Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, and is now an attending physician at Kaiser Permanente, Lafayette, Colorado. Cary Hilbert was a research coordinator at Perelman School of Medicine at the University of Pennsylvania, and is now an epidemiologist at the Centers for Disease Control and Prevention, Atlanta, Georgia. Stephanie Maillie is a clinical nurse specialist at the Hospital of the University of Pennsylvania. C. Jessica Dine is an assistant professor, Scott D. Halpern is an associate professor, and Meeta Prasad Kerlin is an assistant professor, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania. Halpern is director and Kerlin is faculty at the Palliative and Acute Illness Research (PAIR) Center; Halpern is director of the Fostering Improvement in End-of-Life Decision Science (FIELDS) Program; and Dine, Halpern, and Kerlin are senior fellows of the Leonard Davis Institute of Health Economics of the University of Pennsylvania.
• Am. J. Crit. Care. 2017 May 1; 26 (3): 203-209.

BackgroundEvidence suggests that in-person management by nighttime intensivists does not change patients' mortality rates in high-intensity intensive care units.ObjectiveTo better understand domains affected by nighttime intensivist staffing not previously measured.MethodsSemistructured interviews of 13 night-shift nurses in an academic medical intensive care unit to elicit perceptions of nighttime staffing with attending intensivists versus residents with attending intensivists on call remotely. Interviews were done during the final months of a randomized trial comparing the same staffing models. Qualitative analysis was done by using a grounded theory approach. Three investigators independently reviewed interview transcripts to identify key domains.ResultsIn addition to 5 themes probed during interviews (efficiency, communication, job place comfort, quality of patient care, and procedures), participants identified 3 other themes (supervision, systems issues, and experience). Most participants thought that nighttime intensivists improved clinical care, procedures, efficiency, communication, and job place comfort. Two thought that the quality of patient care, efficiency, or communication was the same with both arrangements. Three reported no effect on their job place comfort. Twelve mentioned improved supervision of trainees, and all thought systems issues improved.ConclusionsNurses perceive improvements with nighttime intensivists in several domains. Future work is needed to determine whether such perceptions translate into improved outcomes for staff or patients.©2017 American Association of Critical-Care Nurses.

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