Association Between Attending Physician Transition Days and Liberation from Mechanical Ventilation in the Intensive Care Unit

IntroductionTransitions of care among ICU physicians have been shown to negatively affect care processes and could impact clinical outcomes. Liberation from mechanical ventilation is a judgment-based decision and may be delayed when continuity is disrupted by physician handoffs.ObjectiveTo assess the association between attending physician transitions of care and liberation of patients from mechanical ventilation.MethodsRetrospective cohort study. 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.ResultsOf 3657 ICU days were analyzed, 2732 (74.7%) occurred on non-switch days and 925 (25.3%) on transition days. There were no ventilator liberations on 497 (53.7%) transition days, 1 liberation on 292 (31.56%) transition days, 2 liberations on 105 (11.4%) transition days, and >2 liberations on 31 (3.4%) days. Among non-transition days, there were 0 (1356 [49.6%]), 1 (920 [33.7%], 2 (357 [13.1%]), and >2 (99 [3.6%]) ventilator liberations per day. Transition days were associated with a 10% lower rate of liberations per ICU-day (aIRR 0.90, 95%CI 0.88-0.91, p < 0.01). There was no association between transition day and reintubation (aIRR 0.91, 95% CI 0.73-1.13).ConclusionsAttending physician transition days were associated with a reduction in rates of ventilator liberation. Physician transition is a potentially modifiable contributor to delayed liberation from mechanical ventilation.