An examination of cardiovascular intensive care unit mortality based on admission day and time

Langston, Matthew C.; Subedi, Keshab; Fabrizio, Carly; Wimmer, Neil J.; Choudhry, Usman; Urrutia, Luis

doi:10.1016/j.hrtlng.2021.02.011

Cited by 4 publications

(4 citation statements)

References 25 publications

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“…16,25,26 Additional subpopulations studies of critically-ill patients (eg, surgical ICUs, cardiac ICUs, and patients with strokes) have also found suggestions of a weekend effect. 15,16,18,19,25,26 The findings of our study are particularly unanticipated given the focus on patients receiving MV, a fundamentally sicker population than has been previously studied and one that may be more vulnerable to potential fluctuations in hospital resources on weekends (eg, respiratory therapy or nurse staffing).…”

Section: Discussionmentioning

confidence: 90%

“…Some theories, although debated in the literature, attribute the weekend effect to variable staffing on weekends. 4,12,18,25 Staffing may be more consistent for the most severely ill patients, such as those receiving MV, with very consistent nurse, respiratory therapy, and intensivist staffing regardless of day-of-week or off-peak hours, as recommended by The Leapfrog Group, 37,38 however more marginally ill patients in the ICU may receive lower staffing levels on weekends.…”

Section: Discussionmentioning

confidence: 99%

“…However, studies have shown mixed results with several demonstrating increased mortality in weekend ICU admissions, possibly mediated by care complications such as delays to ICU bed placement, health care associated pneumonia (HAP), and reintubation. [15][16][17][18][19][20] Conversely, other studies have not shown an association. [21][22][23] These varied results are reflected in systematic reviews and metaanalyses arriving at mixed conclusions that, in aggregate, may suggest a modest weekend effect.…”

Section: Introductionmentioning

confidence: 87%

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Association of Hospital Mortality With Initiation of Mechanical Ventilation on a Weekend: A Retrospective Cohort Study

Rai

Douglas

Mehta

2023

J Intensive Care Med

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Rationale Increased mortality in patients admitted to hospitals on weekends is a well-described phenomenon labeled the “weekend effect.” Studies evaluating the weekend effect in intensive care units (ICUs) have arrived at conflicting results. Identifying a weekend effect for critically-ill patients may inform clinical care pathways and resource allocation. Objectives Determine the association of initiation of mechanical ventilation (MV) upon admission on a weekend versus weekday with hospital mortality. Methods We conducted a retrospective cohort study of non-surgical adult patients using the California Patient Discharge Database from 2018 to 2019. We identified MV initiated on the day of admission and diagnoses using discharge billing codes. The primary exposure was admission and initiation of MV on a weekend versus weekday and the primary outcome was hospital mortality. Hierarchical logistic regression was used to determine the association between hospital mortality and MV initiation timing, adjusting for case-mix. Results Among 90 288 admissions in 2018 and 2019 meeting inclusion criteria, 24 771 (27.5%) had MV initiated on weekends, while 65 517 (72.6%) had MV initiated on weekdays. Patient demographics and comorbidities were similar between groups. Chronic alcohol and substance use disorders, and acute intoxications and traumas were more prevalent among patients with MV initiated on weekends. No difference in hospital mortality was observed with initiation of MV on weekends versus weekdays (23.1% vs 22.8%, ARD = 0.3%, aOR = 1.02, 95% CI 0.98, 1.07). Conclusions Contrary to prior studies, no increased mortality was observed among newly admitted patients initiated on MV on weekends compared to weekdays. While weekend effects may exist in other settings, newly admitted patients likely have MV initiated in the emergency department or ICU, which tend to have more consistent staffing levels. Further research is needed to determine if care patterns in these units could be used as a model for units where weekend effects continue to impact outcomes.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 87%

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Association of Hospital Mortality With Initiation of Mechanical Ventilation on a Weekend: A Retrospective Cohort Study

Rai

Douglas

Mehta

2023

J Intensive Care Med

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“…Repletion regimens vary by institution, individual patient factors, and provider factors, resulting in clinical treatment following hospital routine and not the patients' needs [15]. This may result in the delivery of interrupted care during the day due to work organization and non-clinical indicators [22][23][24]. The local culture in electrolyte replacement may be another factor influencing decision making for electrolyte replacement.…”

Section: Introductionmentioning

confidence: 99%

Examination of Electrolyte Replacements in the ICU Utilizing MIMIC-III Dataset Demonstrates Redundant Replacement Patterns

2021

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Electrolyte repletion in the ICU is one of the most ubiquitous tasks in critical care, involving significant resources while having an unclear risk/benefit ratio. Prior data indicate most replacements are administered while electrolytes are within or above reference ranges with little effect on serum post-replacement levels and potential harm. ICU electrolyte replacement patterns were analyzed using the MIMIC-III database to determine the threshold governing replacement decisions and their efficiency. The data of serum values for potassium, magnesium, and phosphate before and after repletion events were evaluated. Thresholds for when repletion was administered and temporal patterns in the repletion behaviors of ICU healthcare providers were identified. Most electrolyte replacements happened when levels were below or within reference ranges. Of the lab orders placed, a minuscule number of them were followed by repletion. Electrolyte repletion resulted in negligible (phosphate), small (potassium), and modest (magnesium) post-replacement changes in electrolyte serum levels. The repletion pattern followed hospital routine work and was anchored around shift changes. A subset of providers conducting over-repletion in the absence of clinical indication was also identified. This pattern of behavior found in this study supports previous studies and may allude to a universal pattern of over-repletion in the ICU setting.

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Impact of late-night liver transplantation on recipient outcome

Carton,

Le Pabic,

Thobie

et al. 2024

Updates Surg

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An examination of cardiovascular intensive care unit mortality based on admission day and time

Cited by 4 publications

References 25 publications

Association of Hospital Mortality With Initiation of Mechanical Ventilation on a Weekend: A Retrospective Cohort Study

Association of Hospital Mortality With Initiation of Mechanical Ventilation on a Weekend: A Retrospective Cohort Study

Examination of Electrolyte Replacements in the ICU Utilizing MIMIC-III Dataset Demonstrates Redundant Replacement Patterns

Impact of late-night liver transplantation on recipient outcome

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