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Hospital mortality among adults admitted to and discharged from intensive care on weekends and evenings.
J Crit Care 2008; 23(3):317-24JC

Abstract

PURPOSE

Patient care may be inconsistent during off hours. We sought to determine whether adults admitted to or discharged from intensive care units (ICUs) on evenings and weekends have increased mortality rates.

MATERIALS AND METHODS

All adults admitted to ICUs in the Calgary Health Region, Alberta, Canada, during 2000 to 2006 were included. The in-hospital mortality risk was assessed with admissions or discharges on weekdays (Monday to Friday) and daytime (8:00 am to 5:59 pm) as compared with weekends (Saturday and Sunday) and nights (6:00 pm to 7:59 am).

RESULTS

Intensive care unit admissions (n = 20466) occurred during weekends in 18%, nights in 41%, and nights and/or weekends in 49%. Among the 17864 survivors to ICU discharge, 26% were discharged on weekends, 21% at night, and 41% on nights and/or weekends. Increased crude mortality rates were associated with both admission (24% vs 14%, P < .0001) and discharge (12% vs 5%, P < .0001) during nights as compared with days. Admission to (26% vs 16%, P < .0001) but not discharge from (6% vs 7%, P = .42) ICU during weekends as compared with weekdays was associated with increased mortality. After controlling for confounding variables using logistic regression analyses, neither weekend admission nor discharge was associated with death. However, both night admission and discharge were independently associated with mortality.

CONCLUSIONS

Our observations of excess risk associated with admission to or discharge from ICU at night merits further exploration as to whether it may reflect inconsistencies in care after hours.

Authors+Show Affiliations

Department of Critical Care Medicine, University of Calgary and Calgary Health Region, Calgary, Alberta, Canada.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18725035

Citation

Laupland, Kevin B., et al. "Hospital Mortality Among Adults Admitted to and Discharged From Intensive Care On Weekends and Evenings." Journal of Critical Care, vol. 23, no. 3, 2008, pp. 317-24.
Laupland KB, Shahpori R, Kirkpatrick AW, et al. Hospital mortality among adults admitted to and discharged from intensive care on weekends and evenings. J Crit Care. 2008;23(3):317-24.
Laupland, K. B., Shahpori, R., Kirkpatrick, A. W., & Stelfox, H. T. (2008). Hospital mortality among adults admitted to and discharged from intensive care on weekends and evenings. Journal of Critical Care, 23(3), pp. 317-24. doi:10.1016/j.jcrc.2007.09.001.
Laupland KB, et al. Hospital Mortality Among Adults Admitted to and Discharged From Intensive Care On Weekends and Evenings. J Crit Care. 2008;23(3):317-24. PubMed PMID: 18725035.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hospital mortality among adults admitted to and discharged from intensive care on weekends and evenings. AU - Laupland,Kevin B, AU - Shahpori,Reza, AU - Kirkpatrick,Andrew W, AU - Stelfox,H Thomas, PY - 2007/06/19/received PY - 2007/08/28/revised PY - 2007/09/24/accepted PY - 2008/8/30/pubmed PY - 2008/12/17/medline PY - 2008/8/30/entrez SP - 317 EP - 24 JF - Journal of critical care JO - J Crit Care VL - 23 IS - 3 N2 - PURPOSE: Patient care may be inconsistent during off hours. We sought to determine whether adults admitted to or discharged from intensive care units (ICUs) on evenings and weekends have increased mortality rates. MATERIALS AND METHODS: All adults admitted to ICUs in the Calgary Health Region, Alberta, Canada, during 2000 to 2006 were included. The in-hospital mortality risk was assessed with admissions or discharges on weekdays (Monday to Friday) and daytime (8:00 am to 5:59 pm) as compared with weekends (Saturday and Sunday) and nights (6:00 pm to 7:59 am). RESULTS: Intensive care unit admissions (n = 20466) occurred during weekends in 18%, nights in 41%, and nights and/or weekends in 49%. Among the 17864 survivors to ICU discharge, 26% were discharged on weekends, 21% at night, and 41% on nights and/or weekends. Increased crude mortality rates were associated with both admission (24% vs 14%, P < .0001) and discharge (12% vs 5%, P < .0001) during nights as compared with days. Admission to (26% vs 16%, P < .0001) but not discharge from (6% vs 7%, P = .42) ICU during weekends as compared with weekdays was associated with increased mortality. After controlling for confounding variables using logistic regression analyses, neither weekend admission nor discharge was associated with death. However, both night admission and discharge were independently associated with mortality. CONCLUSIONS: Our observations of excess risk associated with admission to or discharge from ICU at night merits further exploration as to whether it may reflect inconsistencies in care after hours. SN - 1557-8615 UR - https://www.unboundmedicine.com/medline/citation/18725035/Hospital_mortality_among_adults_admitted_to_and_discharged_from_intensive_care_on_weekends_and_evenings_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(07)00147-5 DB - PRIME DP - Unbound Medicine ER -