Impact of a Novel Split Week Intensivist Model on Outcomes and Quality in a High-Acuity Academic ICU

Introduction: There has been growing interest in the impact of intensivist staffing models on clinical care and physician wellbeing. While the traditional 7-day attending schedule supports continuity, emerging evidence shows that shorter stretches may reduce burnout without compromising patient care. Our study investigated the association between a Split Week Intensivist Model (SWIM) and ICU patient and quality outcomes.


Methods: In an academic surgical/trauma ICU (SICU), we implemented a part-time, voluntary work schedule, in which one intensivist worked 4 consecutive day-shifts and a second intensivist worked the next 3 (SWIM). Retrospective clinical data were analyzed from July to December 2024 during SWIM and non-SWIM weeks. The primary outcome was SICU mortality. Secondary outcomes included SICU length of stay (LOS), acute kidney injury (AKI), duration of mechanical ventilation, and days with central lines and Foley catheters. In addition to descriptive statistics, multivariable regression models were used to examine the association of SWIM with clinical outcomes.


Results: During the study period, there were 648 encounters within the SICU, 174 (27%) from SWIM and 474 (73%) from non-SWIM weeks. Both cohorts had similar proportions of males (50% vs 56%), Blacks (28% for both), Hispanics (3.5% vs 5.1%), and comorbidities (Van Walraven Score, 4.3 for both). ICU mortality was low for SWIM and non-SWIM groups (7.5% vs 7.6%), with similar risk-adjusted odds of death (1.07 [0.47-2.4] vs 0.98 [0.51-1.90]). ICU LOS was also comparable (mean [SD], 6.0 [6.0] vs 5.8 [6.3] days). There were no significant differences in rates of AKI, duration of mechanical ventilation, and days with central lines and Foley catheters between groups. In addition, 70% of participating intensivists preferred the SWIM model of care.


Conclusions: Our pilot SWIM model of care demonstrated comparable SICU outcomes to those of the traditional 7-day model, suggesting the former approach ensures patient safety. Further, most intensivists preferred SWIM, underscoring its potential to enhance provider wellbeing without compromising quality. These findings support the feasibility and safety of implementing more flexible staffing models in high-acuity settings.