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Off hour admission to an intensivist-led ICU is not associated with increased mortality.
Crit Care 2009; 13(3):R84CC

Abstract

INTRODUCTION

Caring for the critically ill is a 24-hour-a-day responsibility, but not all resources and staff are available during off hours. We evaluated whether intensive care unit (ICU) admission during off hours affects hospital mortality.

METHODS

This retrospective multicentre cohort study was carried out in three non-academic teaching hospitals in the Netherlands. All consecutive patients admitted to the three ICUs between 2004 and 2007 were included in the study, except for patients who did not fulfil APACHE II criteria (readmissions, burns, cardiac surgery, younger than 16 years, length of stay less than 8 hours). Data were collected prospectively in the ICU databases. Hospital mortality was the primary endpoint of the study. Off hours was defined as the interval between 10 pm and 8 am during weekdays and between 6 pm and 9 am during weekends. Intensivists, with no responsibilities outside the ICU, were present in the ICU during daytime and available for either consultation or assistance on site during off hours. Residents were available 24 hours a day 7 days a week in two and fellows in one of the ICUs.

RESULTS

A total of 6725 patients were included in the study, 4553 (67.7%) admitted during daytime and 2172 (32.3%) admitted during off hours. Baseline characteristics of patients admitted during daytime were significantly different from those of patients admitted during off hours. Hospital mortality was 767 (16.8%) in patients admitted during daytime and 469 (21.6%) in patients admitted during off hours (P < 0.001, unadjusted odds ratio 1.36, 95%CI 1.20-1.55). Standardized mortality ratios were similar for patients admitted during off hours and patients admitted during daytime. In a logistic regression model APACHE II expected mortality, age and admission type were all significant confounders but off-hours admission was not significantly associated with a higher mortality (P = 0.121, adjusted odds ratio 1.125, 95%CI 0.969-1.306).

CONCLUSIONS

The increased mortality after ICU admission during off hours is explained by a higher illness severity in patients admitted during off hours.

Authors+Show Affiliations

ICU, Reinier de Graaf Groep, Reinier de Graafweg 3-11, 2625 AD Delft, Netherlands. meynaar@rdgg.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

19500333

Citation

Meynaar, Iwan A., et al. "Off Hour Admission to an Intensivist-led ICU Is Not Associated With Increased Mortality." Critical Care (London, England), vol. 13, no. 3, 2009, pp. R84.
Meynaar IA, van der Spoel JI, Rommes JH, et al. Off hour admission to an intensivist-led ICU is not associated with increased mortality. Crit Care. 2009;13(3):R84.
Meynaar, I. A., van der Spoel, J. I., Rommes, J. H., van Spreuwel-Verheijen, M., Bosman, R. J., & Spronk, P. E. (2009). Off hour admission to an intensivist-led ICU is not associated with increased mortality. Critical Care (London, England), 13(3), pp. R84. doi:10.1186/cc7904.
Meynaar IA, et al. Off Hour Admission to an Intensivist-led ICU Is Not Associated With Increased Mortality. Crit Care. 2009;13(3):R84. PubMed PMID: 19500333.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Off hour admission to an intensivist-led ICU is not associated with increased mortality. AU - Meynaar,Iwan A, AU - van der Spoel,Johan I, AU - Rommes,Johannes H, AU - van Spreuwel-Verheijen,Margot, AU - Bosman,Rob J, AU - Spronk,Peter E, Y1 - 2009/06/05/ PY - 2009/02/13/received PY - 2009/04/27/revised PY - 2009/06/05/accepted PY - 2009/6/9/entrez PY - 2009/6/9/pubmed PY - 2009/10/29/medline SP - R84 EP - R84 JF - Critical care (London, England) JO - Crit Care VL - 13 IS - 3 N2 - INTRODUCTION: Caring for the critically ill is a 24-hour-a-day responsibility, but not all resources and staff are available during off hours. We evaluated whether intensive care unit (ICU) admission during off hours affects hospital mortality. METHODS: This retrospective multicentre cohort study was carried out in three non-academic teaching hospitals in the Netherlands. All consecutive patients admitted to the three ICUs between 2004 and 2007 were included in the study, except for patients who did not fulfil APACHE II criteria (readmissions, burns, cardiac surgery, younger than 16 years, length of stay less than 8 hours). Data were collected prospectively in the ICU databases. Hospital mortality was the primary endpoint of the study. Off hours was defined as the interval between 10 pm and 8 am during weekdays and between 6 pm and 9 am during weekends. Intensivists, with no responsibilities outside the ICU, were present in the ICU during daytime and available for either consultation or assistance on site during off hours. Residents were available 24 hours a day 7 days a week in two and fellows in one of the ICUs. RESULTS: A total of 6725 patients were included in the study, 4553 (67.7%) admitted during daytime and 2172 (32.3%) admitted during off hours. Baseline characteristics of patients admitted during daytime were significantly different from those of patients admitted during off hours. Hospital mortality was 767 (16.8%) in patients admitted during daytime and 469 (21.6%) in patients admitted during off hours (P < 0.001, unadjusted odds ratio 1.36, 95%CI 1.20-1.55). Standardized mortality ratios were similar for patients admitted during off hours and patients admitted during daytime. In a logistic regression model APACHE II expected mortality, age and admission type were all significant confounders but off-hours admission was not significantly associated with a higher mortality (P = 0.121, adjusted odds ratio 1.125, 95%CI 0.969-1.306). CONCLUSIONS: The increased mortality after ICU admission during off hours is explained by a higher illness severity in patients admitted during off hours. SN - 1466-609X UR - https://www.unboundmedicine.com/medline/citation/19500333/Off_hour_admission_to_an_intensivist_led_ICU_is_not_associated_with_increased_mortality_ L2 - https://ccforum.biomedcentral.com/articles/10.1186/cc7904 DB - PRIME DP - Unbound Medicine ER -