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

Abstract

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.

Time of Pediatric Intensive Care Unit Admission and Mortality: A Systematic Review and Meta-Analysis

“…After exclusion of articles during title and abstract screening, we identified 33 articles as eligible. Of these, 23 were adult studies [6][7][8]10,[12][13][14][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] and hence excluded (►Fig. for this review.…”

“…Similar trends of peak mortality during morning hours were reported by adult studies. 13,27,28 Handover time as a risk factor for increased mortality needs to be evaluated further.…”

ROSC rates and live discharge rates after cardiopulmonary resuscitation by different CPR teams - a retrospective cohort study

“…The differences in CPR outcomes between the RR and the resident teams might be attributed to either patient-related factors that we were unable to control for, or effects occurring during the night and over weekends. Previous studies have reported that hospitals tend to attend to patients with a greater severity of illness at night; hence, the in-hospital CPR conducted during the night yielded lower ROSC rates [ 10 ]. Further, because these studies [ 11 , 12 ] analyzed the nighttime or weekend effects within the same CPR system, it is likely that patient-related factors and fatigue levels of the medical staff contributed to the lower ROSC rates..…”

Variation in quality of acute stroke care by day and time of admission: prospective cohort study of weekday and weekend centralised hyperacute stroke unit care and non-centralised services

“…There is conflicting evidence as to whether or not patients presenting with acute stroke symptoms receive lower quality of care and have worse outcomes if admitted to hospital outside of normal weekday working hours or at weekends (the ‘weekend effect’). Some studies have shown that acute stroke patients admitted at weekends have lower quality of care1 2 and higher mortality,1–10 while others have shown the opposite 11–14. Evaluation of these studies is further complicated by recent evidence that stroke incidence reporting at the weekend may be unreliable in older studies 15.…”