[Is nighttime intensivist staffing beneficial?].

If an intensive care unit (ICU) is managed by intensivists, the prognosis of critically ill patients improves. Some retrospective analyses of patient databases suggest that critically ill patients admitted to the ICU during off-hours suffer a higher mortality rate compared to patients admitted during office hours. While this suggests that this difference might be related to the presence/absence of experienced intensivists at night, differences in case mix of patients admitted during the day/night may play an important role. Recently, the first prospective randomized controlled trial was published on this issue. Alternating every 7 nights an intensivist was present in the hospital or was available for consultation by telephone. No effect on ICU-length of stay, mortality or any of the secondary end points was found. Despite the compelling face value of nighttime intensivist staffing this practice should not be recommended in the absence of experimental evidence of its effectiveness.