Association Between ICU Admission During Morning Rounds and Mortality

Abstract

Background:No previous study has evaluated the association between admission to ICUs during round time and patient outcome. The objective of this study was to determine the association between round-time ICU admission and patient outcome. Methods: This retrospective study included 49,844 patients admitted from October 1994 to December 2007 to four ICUs (two surgical, one medical, and one multispecialty) of an academic medical center. Of these patients, 3,580 were admitted to the ICU during round time (8:00 AM to 10:59 AM) and 46,264 were admitted during nonround time (from 1:00 PM to 6:00 AM). The medical ICU had 24-h/7-day per week intensivist coverage during the last 2 years of the study. We compared the baseline characteristics and outcome of patients admitted to the ICU between the two groups. Data were abstracted from the acute physiology and chronic health evaluation (APACHE) III database. Results: The round-time and non-round-groups were similar in gender, ethnicity, and age. The predicted hospital mortality rate of the round time group was higher (17.4% vs 12.3% predicted, respectively; p < 0.001). The hospital length of stay was similar between the two groups. The round-time group had a higher hospital mortality rate (16.2% vs 8.8%, respectively; p < 0.001). Most of the round-time ICU admissions and deaths occurred in the medical ICU. Round-time admission was an independent risk factor for hospital death (odds ratio, 1.321; 95% CI, 1.178 to 1.481). This independent association was present for the whole study period except for the last 2 years. Conclusions: Patients admitted to the ICU during morning rounds have higher severity of illness and mortality rates.

Does Admission During Morning Rounds Increase the Mortality of Patients in the Medical ICU?

“…After adjusting for this factor, hospital mortality was not different between patients admitted during morning rounds and those admitted during non-morning rounds. Our observation that patients admitted during morning rounds were sicker was similar to the study by Afessa et al 14 These authors reported a signifi cantly higher median APACHE (Acute Physiology and Chronic Health Evaluation) III score during morning rounds compared with that observed in the non-morning rounds group. These differences may suggest an extended delay of the transfer and management of the patients from other wards to the Variables included in the Cox multivariate proportional hazards model were admission during the morning round period, a medical cause for admission, direct admission from home, age (stratifi ed into four categories), McCabe score, Glasgow Coma Scale score on admission Յ 8, SOFA score on admission Ն 6, and admission diagnosis (seven categories).…”

“…Afessa et al 14 reported an increased mortality rate when patients were admitted during morn ing rounds. Teaching, providing information to families and relatives, and delivering care are some of the duties of the morning ICU medical staff.…”

Avaliação perioperatória de pacientes em unidade de terapia intensiva

“…The infectious complication remains a frequent cause of surgical mortality 18,19 . The infection rate was high, compared to other studies 20 , despite the sharp use of prophylactic antibiotics.…”

Academic Time at a Level 1 Trauma Center: No Resident, No Problem?

“…Afessa et al 19 showed that the patients admitted during the educational rounds in the morning had significantly higher severe illness and poorer clinical outcome in the intensive care unit. An adjusted odds ratio of rounding time admission for hospital mortality was 1.42 (p ϭ 0.016) in the surgical intensive care unit.…”