Abstract Rationale Whether continuous 24/7 intensivist presence improves patient outcomes beyond daytime-only or on-call coverage remains uncertain. Some observational studies show improved survival with around-the-clock staffing, whereas randomized controlled trials (RCTs) have not demonstrated a clear mortality benefit. Differences in ICU organization, staffing resources, and baseline care models further complicate interpretation. This meta-analysis evaluated whether 24/7 onsite intensivist presence, compared with daytime-only or open/on-call models, improves hospital and ICU mortality as well as length of stay, mechanical ventilation duration, and ICU readmissions. Methods A systematic review and meta-analysis were performed according to PRISMA 2020 guidelines. PubMed, Embase, Cochrane CENTRAL, and Web of Science were searched from 2000-2024. Eligible studies compared continuous 24/7 in-house intensivist coverage with daytime-only or open/on-call models in adult ICUs. Random-effects meta-analyses (DerSimonian-Laird with Hartung-Knapp adjustment) pooled risk ratios (RR) for mortality and readmissions, and mean differences (MD) for continuous outcomes. Heterogeneity was assessed using the I² statistic. Subgroup analyses were performed by hospital type, ICU model, and study design. Risk of bias was evaluated using RoB 2.0 for RCTs and ROBINS-I for observational studies. Results Fifteen studies met inclusion criteria; thirteen (≈210,000 patients) contributed to hospital mortality analysis, and ten reported ICU mortality. Continuous around-the-clock intensivist coverage significantly reduced hospital mortality compared with daytime or on-call coverage (RR 0.93, 95% CI 0.89-0.98; p = 0.004; I² = 42%). ICU mortality showed a nonsignificant trend toward lower mortality (RR 0.95, 95% CI 0.90-1.00; p = 0.052; I² = 47%). No significant differences were seen in hospital length of stay (MD − 0.35 days, 95% CI − 0.89 to 0.22), ICU stay (MD − 0.12 days, 95% CI − 0.56 to 0.31), ventilation duration (MD − 0.25 days, 95% CI − 0.78 to 0.28), or ICU readmissions (RR 0.95, 95% CI 0.87-1.04). Mortality benefit was greater in community hospitals (RR 0.89, 95% CI 0.82-0.97) and open-model ICUs (RR 0.87, 95% CI 0.79-0.95), while RCTs showed no effect (RR 0.99, 95% CI 0.90-1.09). Conclusion Continuous intensivist presence reduces hospital mortality and trends toward lower ICU mortality but does not consistently improve stay duration, ventilation, or readmissions. The benefit appears greater in community and open-model ICUs and absent in closed, academic settings. Because most data derive from observational studies, large randomized trials are needed to determine whether universal 24/7 staffing improves outcomes across diverse ICU environments. This abstract is funded by: None
Irshad et al. (Fri,) studied this question.