Mortality after discharge from the intensive care unit during the early weekend period: a population‐based cohort study in Denmark

Obel, Niels; Schierbeck, Jens; Pedersen, Lars; Storgaard, Merete; Pedersen, Court; Sørensen, H.T.; Hansen, Bjarne Lühr

doi:10.1111/j.1399-6576.2007.01431.x

Cited by 26 publications

(23 citation statements)

References 14 publications

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“…Four studies have found increased mortality for patients who were admitted on weekends, compared to patients admitted on weekdays. [23][24][25][26][27][28] We also found an increased mortality risk associated with being admitted outside of normal working hours (Exhibit 1). Increased risk associated with off-hours admission has been demonstrated in studies of highly selected groups of patients with specific diagnoses such as myocardial infarction 26 and in studies of patients undergoing specific interventions, such as treatment of hip fracture 28 or cardiac arrest.…”

Section: Discussionmentioning

confidence: 65%

High Levels Of Bed Occupancy Associated With Increased Inpatient And Thirty-Day Hospital Mortality In Denmark

2014

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High bed occupancy rates have been considered a matter of reduced patient comfort and privacy and an indicator of high productivity for hospitals. Hospitals with bed occupancy rates of above 85 percent are generally considered to have bed shortages. Little attention has been paid to the impact of these shortages on patients' outcomes. We analyzed all 2.65 million admissions to Danish hospitals' departments of medicine in the period 1995-2012. We found that high bed occupancy rates were associated with a significant 9 percent increase in rates of in-hospital mortality and thirty-day mortality, compared to low bed occupancy rates. Being admitted to a hospital outside of normal working hours or on a weekend or holiday was also significantly associated with increased mortality. The health risks of bed shortages, including mortality, could be better documented as a priority health issue. Resources should be allocated to researching the causes and effects of bed shortages, with the aim of creating greater interest in exploring new methods to avoid or reduce bed shortages.

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Section: Discussionmentioning

confidence: 65%

High Levels Of Bed Occupancy Associated With Increased Inpatient And Thirty-Day Hospital Mortality In Denmark

2014

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“…Research has demonstrated that being discharged from ICU after hours increases the risk of readmission and post-ICU mortality (Gopal et al, 2010;Pilcher et al, 2007). Key reasons for this may include lower staffing levels on the wards at night time combined with inadequate clinical handover or poor appraisal of patient needs (Obel et al, 2007;Singh et al, 2010).…”

Section: Discussionmentioning

confidence: 98%

Intensive care readmission: A contemporary review of the literature

Elliott

Worrall‐Carter

Page

2014

Intensive and Critical Care Nursing

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“…Discharge season was included to control for seasonal illness variation (25–27) and was categorized as September–November, December–February, March–May, and June–August. Two binary discharge time variables were included to explore the relevance of evening (14, 28, 29) and weekend transfers (30). As a proxy for severity of illness at admission, a predicted probability of mortality was estimated using Paediatric Index of Mortality (PIM) 2 (31).…”

Section: Methodsmentioning

confidence: 99%

Frequency, Risk Factors, and Outcomes of Early Unplanned Readmissions to PICUs*

Edwards

Lucas

Stone

et al. 2013

Critical Care Medicine

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Objectives To determine the rate of unplanned PICU readmissions, examine the characteristics of index admissions associated with readmission, and compare outcomes of readmissions versus index admissions. Design Retrospective cohort analysis. Setting Ninety North American PICUs that participated in the Virtual Pediatric Intensive Care Unit Systems. Patients One hundred five thousand four hundred thirty-seven admissions between July 2009 and March 2011. Interventions None. Measurements and Main Results Unplanned PICU readmission within 48 hours of index discharge was the primary outcome. Summary statistics, bivariate analyses, and mixed-effects logistic regression model with random effects for each hospital were performed. There were 1,161 readmissions (1.2%). The readmission rate varied among PICUs (0–3.3%), and acute respiratory (56%), infectious (35%), neurological (28%), and cardiovascular (20%) diagnoses were often present on readmission. Readmission risk increased in patients with two or more complex chronic conditions (adjusted odds ratio, 1.72; p < 0.001), unscheduled index admission (adjusted odds ratio, 1.37; p < 0.001), and transfer to an intermediate unit (adjusted odds ratio, 1.29; p = 0.004, compared with ward). Trauma patients had a decreased risk of readmission (adjusted odds ratio, 0.67; p = 0.003). Gender, race, insurance, age more than 6 months, perioperative status, and nighttime transfer were not associated with readmission. Compared with index admissions, readmissions had longer median PICU length of stay (3.1 vs 1.7 d, p < 0.001) and higher mortality (4% vs 2.5%, p = 0.002). Conclusions Unplanned PICU readmissions were relatively uncommon, but were associated with worse outcomes. Several patient and admission characteristics were associated with readmission. These data help identify high-risk patient groups and inform risk-adjustment for standardized readmission rates.

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Mortality after discharge from the intensive care unit during the early weekend period: a population‐based cohort study in Denmark

Abstract: Medical patients discharged from the ICU early in the weekends seem to have an increased mortality and risk of readmission to the ICU.

Cited by 26 publications

References 14 publications

High Levels Of Bed Occupancy Associated With Increased Inpatient And Thirty-Day Hospital Mortality In Denmark

High Levels Of Bed Occupancy Associated With Increased Inpatient And Thirty-Day Hospital Mortality In Denmark

Intensive care readmission: A contemporary review of the literature

Frequency, Risk Factors, and Outcomes of Early Unplanned Readmissions to PICUs*

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