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Impact of intensive care unit discharge time on patient outcome.
Crit Care Med 2006; 34(12):2946-51CC

Abstract

OBJECTIVE

To determine the impact of nighttime intensive care unit (ICU) discharge on patient outcome.

DESIGN

Multiple-center, retrospective observational cohort study.

SETTING

Canadian hospitals.

PATIENTS

We used a prospectively collected dataset containing information on 79,090 consecutive admissions from 31 Canadian community and teaching hospitals.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Patients were categorized according to the time of ICU discharge into daytime (07:00-20:59) and nighttime (21:00-06:59). Admissions were excluded if the patients were a) </=16 yrs of age (392); b) admitted following cardiac surgery (6,641); c) admitted following the initial admission for patients readmitted to the ICU within the same hospital stay (3,632); d) admitted due to a lack of available ward or specialty care beds (457); or c) transferred to another acute care facility (7,724). We found that 62,056 patients were discharged to the ward following the initial ICU admission. Of the 47,062 discharges eligible for analyses, 10.1% were discharged at night. The unadjusted odds of death for patients discharged from ICU at night was 1.35 (95% confidence interval, 1.23, 1.49), compared with patients discharged during the daytime. After adjustment for illness severity, source, case-mix, age, gender, and hospital size, the mortality risk was increased by 1.22-fold (95% confidence interval, 1.10, 1.36) for nighttime discharges. Multivariate regression analysis revealed that patients discharged from the ICU at night have a significantly shorter ICU length of stay than those discharged during the day (p < .001). Whereas hospital length of stay was similar for daytime and nighttime discharges who survived hospital stay, patients discharged at night who did not survive hospital stay had a significantly shorter hospital length of stay (p = .002).

CONCLUSIONS

Patients discharged from the ICU at night have an increased risk of mortality compared with those discharged during the day.

Authors+Show Affiliations

Department of Medicine, London Health Sciences Centre, London, ON, Canada.No affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study

Language

eng

PubMed ID

17075364

Citation

Priestap, Fran A., and Claudio M. Martin. "Impact of Intensive Care Unit Discharge Time On Patient Outcome." Critical Care Medicine, vol. 34, no. 12, 2006, pp. 2946-51.
Priestap FA, Martin CM. Impact of intensive care unit discharge time on patient outcome. Crit Care Med. 2006;34(12):2946-51.
Priestap, F. A., & Martin, C. M. (2006). Impact of intensive care unit discharge time on patient outcome. Critical Care Medicine, 34(12), pp. 2946-51.
Priestap FA, Martin CM. Impact of Intensive Care Unit Discharge Time On Patient Outcome. Crit Care Med. 2006;34(12):2946-51. PubMed PMID: 17075364.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of intensive care unit discharge time on patient outcome. AU - Priestap,Fran A, AU - Martin,Claudio M, PY - 2006/11/1/pubmed PY - 2006/12/27/medline PY - 2006/11/1/entrez SP - 2946 EP - 51 JF - Critical care medicine JO - Crit. Care Med. VL - 34 IS - 12 N2 - OBJECTIVE: To determine the impact of nighttime intensive care unit (ICU) discharge on patient outcome. DESIGN: Multiple-center, retrospective observational cohort study. SETTING: Canadian hospitals. PATIENTS: We used a prospectively collected dataset containing information on 79,090 consecutive admissions from 31 Canadian community and teaching hospitals. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients were categorized according to the time of ICU discharge into daytime (07:00-20:59) and nighttime (21:00-06:59). Admissions were excluded if the patients were a) </=16 yrs of age (392); b) admitted following cardiac surgery (6,641); c) admitted following the initial admission for patients readmitted to the ICU within the same hospital stay (3,632); d) admitted due to a lack of available ward or specialty care beds (457); or c) transferred to another acute care facility (7,724). We found that 62,056 patients were discharged to the ward following the initial ICU admission. Of the 47,062 discharges eligible for analyses, 10.1% were discharged at night. The unadjusted odds of death for patients discharged from ICU at night was 1.35 (95% confidence interval, 1.23, 1.49), compared with patients discharged during the daytime. After adjustment for illness severity, source, case-mix, age, gender, and hospital size, the mortality risk was increased by 1.22-fold (95% confidence interval, 1.10, 1.36) for nighttime discharges. Multivariate regression analysis revealed that patients discharged from the ICU at night have a significantly shorter ICU length of stay than those discharged during the day (p < .001). Whereas hospital length of stay was similar for daytime and nighttime discharges who survived hospital stay, patients discharged at night who did not survive hospital stay had a significantly shorter hospital length of stay (p = .002). CONCLUSIONS: Patients discharged from the ICU at night have an increased risk of mortality compared with those discharged during the day. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/17075364/Impact_of_intensive_care_unit_discharge_time_on_patient_outcome_ L2 - http://Insights.ovid.com/pubmed?pmid=17075364 DB - PRIME DP - Unbound Medicine ER -