Efecto del momento de ingreso sobre el pronóstico de los pacientes en la Unidad de Cuidados Intensivos: on-hours vs. off-hours

Abella, A.; Hermosa, Cecilia; Enciso, V.; Torrejón, I.; Molina, R.; Díaz, M.; Mozo, T.; Gordo, Federico; Salinas, I.

doi:10.1016/j.medin.2014.11.009

Cited by 19 publications

(10 citation statements)

References 26 publications

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“…The observed mortality of patients admitted during weekends falls into the range of 11.1–38.3% previously reported in other studies (1, 4, 15, 17, 19, 21). However, our results failed to support the linear relationship between admissions to ICU during weekends and excess mortality, as suggested in other publications (1, 2, 4, 5, 8, 15, 17, 18, 22). The adverse effects of weekend care, or ‘weekend effect’, resulting from inadequate staffing and support systems are likely to be more pronounced in community hospitals than in tertiary care center ICUs.…”

Section: Discussioncontrasting

confidence: 95%

“…On the contrary, the observed mortality of patients admitted to ICU on weekdays and after-hours was significantly higher than that found in other reviews (3, 8, 15–17, 19, 22). It is important to emphasize that the proportion of patients in our cohort admitted during weekdays and after-hours was higher than that previously reported in other similar studies (3, 15, 16, 19, 23).…”

Section: Discussioncontrasting

confidence: 81%

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Effects of time and day of admission on the outcome of critically ill patients admitted to ICU

Orsini¹,

Rajayer

Ahmad

et al. 2016

Journal of Community Hospital Internal Medicine Perspectives

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BackgroundStudies have shown that patients admitted to hospitals on weekends and after-hours experience worse outcome than those admitted on weekdays and daytime hours. Although admissions of patients to intensive care units (ICUs) occur 24 hours a day, not all critical care units maintain the same level of staffing during nighttime, weekends, and holidays. This raises concerns in view of evidence showing that the organizational structure of an ICU influences the outcome of critically ill patients. The objective of this study is to evaluate the effects of day and time of admission to ICU on patients’ outcome.MethodsA single-center, prospective, observational study was conducted among all consecutive admissions to ICU in a community teaching hospital during a 4-month period.ResultsA total of 282 patients were admitted during the study period. Their mean age was 59.5 years (median 59, range 17–96), and the majority were male (157, 55.7%). Mean Acute Physiology and Chronic Health Evaluation (APACHE)-II score was 18.9 (median 33, range 1–45), and mean ICU length of stay was 3.1 days (median 2, range 1–19). Of the patients, 104 patients (36.9%) were admitted during weekends and 178 (63.1%) during weekdays. A total of 122 patients (43.3%) were admitted after-hours, constituting 68.5% of all admissions during weekdays. Fifty-six patients (19.9%) were admitted during daytime hours, representing 31.5% of all weekday admissions. Forty-five patients (15.9%) died in ICU. Compared to patients admitted on weekends, those admitted on weekdays had increased ICU mortality (operating room (OR)=0.437; 95% confidence interval=0.2054–0.9196; p=0.0293).ConclusionAdmissions to ICU during weekends were not independently associated with increased mortality. A linear relationship between weekdays and after-hours admissions to ICU with mortality was observed at our institution.

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Section: Discussioncontrasting

confidence: 95%

Section: Discussioncontrasting

confidence: 81%

Effects of time and day of admission on the outcome of critically ill patients admitted to ICU

Orsini¹,

Rajayer

Ahmad

et al. 2016

Journal of Community Hospital Internal Medicine Perspectives

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“…However, an increased mortality has been observed and reported during off-hours, especially during weekend [5, 21]. Several factors have been implicated in this association including reduced medical staff, higher working load, and difficult accessibility to surgical or imaging platform.…”

Section: Discussionmentioning

confidence: 99%

“…Differences in patient characteristics such as disease severity have also been advocated. Though various studies have been conducted in adults [13–19,21–26] and paediatrics [27,28] to assess a link between mortality and time of patient admission, especially for those admitted during weekends, results remain however controversial. Yet, patients admitted for myocardial infarction [10], strokes [9], pulmonary embolism or aortic aneurism rupture [8], have a higher mortality rate when admitted on weekends rather than on weekdays.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, Barnett et al [17], in a study of 150,000 adult patients from 38 ICUs, demonstrated a higher risk-adjusted odd of in-hospital death for patients admitted on weekends as compared to those admitted on weekdays. While some studies showed the weekend impact [13, 21], others highlighted the effect of night-time admission [15,29]. The meta-analysis performed by Cavallazzi et al [5] indicated that an increased risk of death was associated with weekends but not with night-time admissions.…”

Section: Discussionmentioning

confidence: 99%

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Mortality Associated with Night and Weekend Admissions to ICU with On-Site Intensivist Coverage: Results of a Nine-Year Cohort Study (2006-2014)

Brunot¹,

Landreau²,

Corne³

et al. 2016

PLoS ONE

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BackgroundThe association between mortality and time of admission to ICU has been extensively studied but remains controversial. We revaluate the impact of time of admission on ICU mortality by retrospectively investigating a recent (2006–2014) and large ICU cohort with on-site intensivist coverage.Patients and MethodsAll adults (≥ 18 years) admitted to a tertiary care medical ICU were included in the study. Patients' characteristics, medical management, and mortality were prospectively collected. Patients were classified according to their admission time: week working days on- and off-hours, and weekends. ICU mortality was the primary outcome and adjusted Hazard-ratios (HR) of death were analysed by multivariate Cox model.Results2,428 patients were included: age 62±18 years; male: 1,515 (62%); and median SAPSII score: 38 (27–52). Overall ICU mortality rate was 13.7%. Admissions to ICU occurred during open-hours in 680 cases (28%), during night-time working days in 1,099 cases (45%) and during weekends in 649 cases (27%). Baseline characteristics of patients were similar between groups except that patients admitted during the second part of night (00:00 to 07:59) have a significantly higher SAPS II score than others. ICU mortality was comparable between patients admitted during different time periods but was significantly higher for those admitted during the second part of the night. Multivariate analysis showed however that admission during weeknights and weekends was not associated with an increased ICU mortality as compared with open-hours admissions.ConclusionTime of admission, especially weeknight and weekend (off-hour admissions), did not influence the prognosis of ICU patients. The higher illness severity of patients admitted during the second part of the night (00:00–07:59) may explain the observed increased mortality.

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Code ICU - A great opportunity for patients and critical care management

Gordo

Abella

Lobo-Valbuena

2017

Journal of Critical Care

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Efecto del momento de ingreso sobre el pronóstico de los pacientes en la Unidad de Cuidados Intensivos: on-hours vs. off-hours

Cited by 19 publications

References 26 publications

Effects of time and day of admission on the outcome of critically ill patients admitted to ICU

Effects of time and day of admission on the outcome of critically ill patients admitted to ICU

Mortality Associated with Night and Weekend Admissions to ICU with On-Site Intensivist Coverage: Results of a Nine-Year Cohort Study (2006-2014)

Code ICU - A great opportunity for patients and critical care management

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