Association Between Evening Admissions and Higher Mortality Rates in the Pediatric Intensive Care Unit

Abstract

ABSTRACT. Background. Previous research investigating the relationship between the time of admission and mortality rates has yielded inconsistent results and has not been conducted in the pediatric intensive care unit (PICU) patient population.Objective. To determine whether an association between the time of admission (weekday versus weekend and daytime versus evening) and the risk of death exists among pediatric patients included in a cohort of children admitted to a national sample of PICUs.Design/Methods. We analyzed retrospectively a cohort of consecutive admissions to 15 PICUs included in the Pediatric Intensive Care Unit Evaluations database. The odds of death were analyzed by using mixed-effects, multivariate, logistic regression, with clustering at the hospital level. The primary independent variables were admission to the PICU on a weekend and admission to the PICU during evening hours. The severity of illness was adjusted by using the Pediatric Risk of Mortality III probability of death score.Patients. T o improve the quality of care, discrepancies in health care delivery and their effects on patient outcomes must be identified. Recent research has demonstrated that, among large patient cohorts, differences in time of admission are associated with differences in patient outcomes. Bell and Redelmeier 1 identified a significantly higher mortality rate among adult patients admitted on the weekend, compared with similar patients admitted on weekdays. Barnett et al, 2 in a study of Ͼ150 000 adult patients admitted to 38 intensive care units (ICUs), demonstrated both a higher risk-adjusted odds of in-hospital death and a longer ICU length of stay for patients admitted on the weekend, compared with patients admitted on weekdays. Similarly, neonatal mortality rates were shown to be slightly higher among infants born on weekends and during evening hours, compared with those born on weekdays and during daytime hours, respectively. [3][4][5][6][7][8] Whether an association exists between patient outcomes and time of admission in the pediatric patient population is unknown.To address this question, the Pediatric Intensive Care Unit Evaluations (PICUEs) database, representing a cohort of 34 993 pediatric ICU (PICU) patients from 15 institutions in the United States, was analyzed. 9 The objectives of this study were to compare the risk-adjusted mortality rates for weekend admissions versus weekday admissions and the risk-adjusted mortality rates for evening admissions versus daytime admissions. METHODS PatientsData for analysis were obtained from the most current available PICUEs database, Research Dataset 20 -02. 9 This database contains patient-level data from 34 993 admissions to 15 PICUs in the United States. Details of the site-selection procedures for the 15 study sites, general data-collection methods, and other analyses of this data set have been published. 9,10 Briefly, a minimum of 67 demographic, diagnostic physiologic, laboratory, and outcome data points were collected for all patients within 24 hours a...

Influence of weekend versus weekday hospital admission on mortality following subarachnoid hemorrhage

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“…3,[6][7][8]11,[13][14][15][16]23,29,31,34 These databases could potentially include coding errors, usually originating from the hospital level, 9 although it seems likely that such errors would be consistent across the entire database rather than isolated to the weekend admissions. In addition, the database contains discharge records, which include discharges to other hospitals.…”

The effect of weekend and after-hours surgery on morbidity and mortality rates in pediatric neurosurgery patients

“…[1][2][3][4][5][6][7][8][11][12][13][14][15][16]19,20,[23][24][25] The "weekend effect" on pediatric neurosurgical procedures is unknown. Therefore, our primary aim was to abbreviation ASA = American Society of Anesthesiologists.…”

Assessing the Utility of ICU Readmissions as a Quality Metric

“…Th e Centers for Medicare & Medicaid Services evaluated ICU readmissions as a candidate ICU quality indicator 1 based on evidence that readmissions are associated with increased mortality and cost [2][3][4][5][6][7][8][9][10][11][12] and because they are presumed to result from "premature" ICU discharge, 13 bed shortages, 14,15 or poorly orchestrated handoff s. 10,16 However, other reports show that while patients discharged when ICUs are more strained have increased odds of ICU readmission, the risk of death is no higher, suggesting that decisions preceding ICU readmissions may not cause the excess mortality with which they are associated. [17][18][19] Additionally, the performance of ICUs on ICU readmissions is not correlated with performance on other measures of ICU quality, such as mortality or process measures.…”