Turning 'Night into Day': Challenges, Strategies, and Effectiveness of Re-engineering the Workflow to Enable Continuous Electronic Intensive Care Unit Collaboration Between Australia and U.S

Safe and effective care of critically ill patients requires a team of professionals including specialty physicians (intensivists) and critical care nurses experienced in providing care for patients in the intensive care unit (ICU). While critical illness can strike at any time and demands continuous attention, allocation of scarce staff follows a predictable pattern. The night shift is more likely to have disproportionately newer and thus less experienced nurses, and the experienced nurses on that shift are engaged in providing care to their own set of patients (Claffey 2006; Floyd 2003). At times this leaves them unable to sufficiently supervise the newer staff. There is also evidence of increased risks at night time with higher in-hospital mortality for admissions at night (Coiera et al. 2014).