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Hospital mortality rate and length of stay in patients admitted at night to the intensive care unit.
Crit Care Med. 2003 Mar; 31(3):858-63.CC

Abstract

OBJECTIVE

Although admission of patients to a medical ward after 5:00 pm has been associated with increased mortality rate and possibly shorter hospital stay, the association between timing of admission to the intensive care unit and outcome has not been studied. The objective of this study was to determine whether there are any associations between the timing of patient admission to a medical intensive care unit and hospital outcome.

DESIGN

A retrospective cohort study that used an Acute Physiology and Chronic Health Evaluation III database containing prospectively collected demographic, clinical, and outcome information for patients. Patients were divided according to the time of admission into daytime (from 7:00 am to 5:00 pm) and nighttime admissions. We further subdivided nighttime admissions into two groups (regular and heavy workload) according to the number of patients who were admitted during the same shift.

SETTING

Medical intensive care unit (a 15-bed unit in an academic referral hospital).

PATIENTS

6,034 patients consecutively admitted to our medical intensive care unit over a 5-yr period starting April 10, 1995.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The patients admitted at night had a lower mortality rate (13.9 vs. 17.2%, p < .0001), adjusted for admission source and severity of illness. Their hospital stay was shorter, 11.0 days +/- 13.5 (median 7) vs. 12.7 +/- 14.8 (median 8; p < .0001), as was their intensive care unit stay, 3.5 +/- 4.4 days (median 2) vs. 3.9 +/- 4.7 (median 2; p < .0001), compared with the daytime admission group. The nighttime shifts that admitted three or more patients (heavy workload) had the same mortality rate (13.2%) as those with fewer admissions (14.5%; p = .5961). Hospital and intensive care unit stays were also similar in both workload groups.

CONCLUSIONS

Nighttime admission to our intensive care unit is not associated with a higher mortality rate or a longer hospital or intensive care unit stay compared with daytime admission.

Authors+Show Affiliations

Morales IJ
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, MN, USA.
Peters SG
No affiliation info available
Afessa B
No affiliation info available

MeSH

APACHEAcademic Medical CentersAdultAgedFemaleHealth Services ResearchHospital MortalityHumansIntensive Care UnitsInternship and ResidencyLength of StayLogistic ModelsMaleMedical Staff, HospitalMiddle AgedMinnesotaNight CareOutcome Assessment, Health CarePatient AdmissionRetrospective StudiesRisk FactorsSurvival AnalysisTime FactorsWorkload

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12626997

Citation

Morales, Ian J., et al. "Hospital Mortality Rate and Length of Stay in Patients Admitted at Night to the Intensive Care Unit." Critical Care Medicine, vol. 31, no. 3, 2003, pp. 858-63.
Morales IJ, Peters SG, Afessa B. Hospital mortality rate and length of stay in patients admitted at night to the intensive care unit. Crit Care Med. 2003;31(3):858-63.
Morales, I. J., Peters, S. G., & Afessa, B. (2003). Hospital mortality rate and length of stay in patients admitted at night to the intensive care unit. Critical Care Medicine, 31(3), 858-63.
Morales IJ, Peters SG, Afessa B. Hospital Mortality Rate and Length of Stay in Patients Admitted at Night to the Intensive Care Unit. Crit Care Med. 2003;31(3):858-63. PubMed PMID: 12626997.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hospital mortality rate and length of stay in patients admitted at night to the intensive care unit. AU - Morales,Ian J, AU - Peters,Steve G, AU - Afessa,Bekele, PY - 2003/3/11/pubmed PY - 2003/4/12/medline PY - 2003/3/11/entrez SP - 858 EP - 63 JF - Critical care medicine JO - Crit Care Med VL - 31 IS - 3 N2 - OBJECTIVE: Although admission of patients to a medical ward after 5:00 pm has been associated with increased mortality rate and possibly shorter hospital stay, the association between timing of admission to the intensive care unit and outcome has not been studied. The objective of this study was to determine whether there are any associations between the timing of patient admission to a medical intensive care unit and hospital outcome. DESIGN: A retrospective cohort study that used an Acute Physiology and Chronic Health Evaluation III database containing prospectively collected demographic, clinical, and outcome information for patients. Patients were divided according to the time of admission into daytime (from 7:00 am to 5:00 pm) and nighttime admissions. We further subdivided nighttime admissions into two groups (regular and heavy workload) according to the number of patients who were admitted during the same shift. SETTING: Medical intensive care unit (a 15-bed unit in an academic referral hospital). PATIENTS: 6,034 patients consecutively admitted to our medical intensive care unit over a 5-yr period starting April 10, 1995. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The patients admitted at night had a lower mortality rate (13.9 vs. 17.2%, p < .0001), adjusted for admission source and severity of illness. Their hospital stay was shorter, 11.0 days +/- 13.5 (median 7) vs. 12.7 +/- 14.8 (median 8; p < .0001), as was their intensive care unit stay, 3.5 +/- 4.4 days (median 2) vs. 3.9 +/- 4.7 (median 2; p < .0001), compared with the daytime admission group. The nighttime shifts that admitted three or more patients (heavy workload) had the same mortality rate (13.2%) as those with fewer admissions (14.5%; p = .5961). Hospital and intensive care unit stays were also similar in both workload groups. CONCLUSIONS: Nighttime admission to our intensive care unit is not associated with a higher mortality rate or a longer hospital or intensive care unit stay compared with daytime admission. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/12626997/Hospital_mortality_rate_and_length_of_stay_in_patients_admitted_at_night_to_the_intensive_care_unit_ DB - PRIME DP - Unbound Medicine ER -