24-hour intensivist staffing is not beneficial for patients

The conceptual argument in favor of 24-hour intensivist staffing certainly seems very sound. Studies of critical illnesses of all sorts (such as, sepsis, stroke, and myocardial infarction) consistently demonstrate the phenomenon of “golden hours”—the early period during which timely recognition and interventions can profoundly impact outcomes of the most vulnerable patients. Therefore, it stands to reason that patients admitted to an ICU might benefit from the immediate availability of a critical care expert. However, the evidence does not lead us to this conclusion. Nonetheless, many institutions are increasingly implementing around-the-clock coverage by intensivists, and so this debate continues. In this Viewpoint, I will argue that 24-hour availability of intensivists does not benefit patients and may even have risks.