B104-10 The Impact of Attending Intensivist Discontinuity on Ventilator Liberation

Abstract Background Discontinuity of care in intensive care units (ICU) may contribute to worse patient outcomes and represents a potentially modifiable aspect of care delivery. The decision to liberate a patient from mechanical ventilation carries substantial risk and often involves subjective considerations. In prior studies, physician transitions in the ICU have been variably associated with care practices, including ventilator liberation decisions. These prior studies, however, have generally used proxies for physician transitions (e.g. first Monday of the week). In this study, we examined the relationship between attending intensivist discontinuity and ventilator liberation in a large retrospective cohort, leveraging electronically captured physician schedules. Methods This was a retrospective cohort study, conducted at three hospitals part of a single urban health system. Patients were included if they were admitted to one of three medical ICUs and received mechanical ventilation between January 2022 and May 2025. Transition days were defined as any day where the daytime attending intensivist was different than the day prior. Transition days were identified by review of schedules recorded on the online scheduling system and were considered separately for each ICU in the health system. Patient data, including ventilator liberation, were abstracted from the medical record. Results A total of 4,970 patients were included in the study over 3,657 ICU days. Of the days included, 925 (25.2%) days were transition days and 2,732 (74.7%) were non-transition days. The distribution of number of ventilator liberations on transition days as compared to non-transition days can be found in the Figure. On transition days, 469 (50.7%) of days had 0 ventilator liberations as compared to 1,285 (47.0%) of non-transition days (χ2=2, p = 0.1573). The median number of ventilator liberations on transition days was 0 (IQR 0-1) and on non-transition days was 1 (IQR 0-1). Patients liberated from the ventilator on transition days required re-intubation 13.3% of the time as compared to 16.1% on non-transition days. Conclusion Days on which the attending intensivist transitioned had a similar number and distribution of ventilator liberation events as days in which there was continuity of attending intensivist. Our study did not examine this finding in relationship to other physician (trainee, overnight intensivist) or advanced practice practitioner discontinuity events. Ongoing effort to examine other modifiable contributors to variation in ventilator liberation decisions is warranted. This abstract is funded by: None