Hospital mortality is associated with ICU admission time

Kuijsten, Hans A. J. M.; Brinkman, Sylvia; Meynaar, Iwan A.; Spronk, Peter E.; Spoel, J. I. van der; Bosman, Rob J.; Keizer, Nicolette F. de; Abu‐Hanna, Ameen; Lange, Dylan W. de

doi:10.1007/s00134-010-1918-1

Cited by 71 publications

(68 citation statements)

References 25 publications

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“…Some authors have given [3][4][5] that the multidisciplinary ratio (medical staff, nursing, pharmacy, laboratory, diagnostic imaging, management etc.) and referral to medical specialists is hampered due to fewer professionals, providing a smaller number diagnostic investigations and therapeutic procedures based on evidence [3][4][5][6]10,[14][15][16] . Another factor that may have important association is related to the fatigue of professionals at night, and these are often the same professionals who worked during the day and stay at night, or who may already have come from other working hours; furthermore, the inversion of sleep-wake cycle can change and attention influence the procedures adopted 3,[17][18][19][20] .…”

Section: Results Results Results Resultsmentioning

confidence: 99%

Night admission is an independent risk factor for mortality in trauma patients - a systemic error approach

Barbosa

Júnior

Chaves

et al. 2015

Rev. Col. Bras. Cir.

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Night admission is an independent risk factor for mortality in Night admission is an independent risk factor for mortality in Night admission is an independent risk factor for mortality in Night admission is an independent risk factor for mortality in Night admission is an independent risk factor for mortality in trauma patients -a systemic error approach trauma patients -a systemic error approach trauma patients -a systemic error approach trauma patients -a systemic error approach trauma patients -a systemic error approach Admissão noturna é fator de risco independente para mortalidade em pacientes Admissão noturna é fator de risco independente para mortalidade em pacientes Admissão noturna é fator de risco independente para mortalidade em pacientes Admissão noturna é fator de risco independente para mortalidade em pacientes Admissão noturna é fator de risco independente para mortalidade em pacientes vítimas de trauma -uma abordagem ao erro sistêmico vítimas de trauma -uma abordagem ao erro sistêmico vítimas de trauma -uma abordagem ao erro sistêmico vítimas de trauma -uma abordagem ao erro sistêmico vítimas de trauma -uma abordagem ao erro sistêmico LEONARDO DE [1][2][3] . Fatigue and lack of supervision to attending physicians may contribute to increased complications and hospital mortality. Such situations, also added to the circadian rhythm and dynamics of abnormal operating changes can be crucial factors for the worst performance in these periods. The cumulative presence of a number of unfavorable conditions is remarkable and very common in these periods, situations that favor and increase vulnerability to error [1][2][3][4][5][6][7][8][9][10] . Specific studies in patients with acute myocardial infarction, ischemic stroke and the Intensive Care Units showed higher rate of clinical complications and hospital mortality in the "off-hours" periods (nighttime or weekends) [4][5][6][7][8][9][10][11][12] . The volume of evidence demonstrating higher incidence of unfavorable outcomes in these adverse conditions weakens the idea of occasional errors as the cause of these events [4][5][6][7][8][9][10] . This highlights the need to analyze these situations trough of a model to interpret the error with a systemic view.Due to the lack of Brazilian studies, this study aimed to verify the impact of the shift of admission of patients who have suffered trauma, underwent surgery, in hospital mortality. According to these results, interpretation models and error correction are discussed. METHODS METHODS METHODS METHODS METHODSThis is a cohort study with retrospective collection of data, which were selected through electronic medical records, patients admitted from November 2011 to March 2012 in the emergency of Hospital do Subúrbio (HS) -a public hospital attending urgency and emergency and public-private administrative nature, in Subúrbio Ferroviá-rio, district of the city of Salvador, Bahia. The study included trauma patients admitted to the emergency HS who underwent surgery and were classified according to Internatio...

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Section: Results Results Results Resultsmentioning

confidence: 99%

Night admission is an independent risk factor for mortality in trauma patients - a systemic error approach

Barbosa

Júnior

Chaves

et al. 2015

Rev. Col. Bras. Cir.

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“…3 A metaanalysis and a large national registry study of adult ICU admissions, each evaluating .130 000 admissions, demonstrated increased odds of death associated with weekend admission. 4,5 In the largest study in the pediatric ICU setting to date, which included .20 000 admissions to 15 PICUs from 1995 to 2001, nighttime admission was associated with increased odds of death. 6 Several smaller studies in PICUs found no difference in riskadjusted mortality for patients admitted during off-hours when compared with weekdays, 7-9 and 1 study found lower risk-adjusted mortality for admissions during off-hours.…”

Section: Resultsmentioning

confidence: 99%

Off-Hours Admission to Pediatric Intensive Care and Mortality

McCrory¹,

Gower

Simpson

et al. 2014

Pediatrics

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BACKGROUND: Critically ill patients are admitted to the pediatric ICU at all times, while staffing and other factors may vary by day of the week or time of day. The purpose of this study was to evaluate whether admission during off-hours is independently associated with mortality in PICUs. METHODS: A retrospective cohort study of admissions of patients <18 years of age to PICUs was performed using the Virtual PICU Systems (VPS, LLC) database. “Off-hours” was defined as nighttime (7:00 pm to 6:59 am) or weekend (Saturday or Sunday any time). Mixed-effects multivariable regression was performed by using Pediatric Index of Mortality 2 (PIM2) to adjust for severity of illness. Primary outcome was death in the pediatric ICU. RESULTS: Data from 234 192 admissions to 99 PICUs from January 2009 to September 2012 were included. When compared with regular weekday admissions, off-hours admissions were less likely to be elective, had a higher risk for mortality by PIM2, and had a higher observed ICU mortality (off-hours 2.7% vs weekdays 2.2%; P < .001). Multivariable regression revealed that, after adjustment for other significant factors, off-hours admission was associated with lower odds of mortality (odds ratio, 0.91; 95% confidence interval, 0.85–0.97; P = .004). Post hoc multivariable analysis revealed that admission during the morning period 6:00 am to 10:59 am was independently associated with death (odds ratio, 1.27; 95% confidence interval, 1.16–1.39; P < .0001). CONCLUSIONS: Off-hours admission does not independently increase odds of death in the PICU. Admission from 6:00 am to 10:59 am is associated with increased risk for death and warrants further investigation in the PICU population.

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“…The potential impact of transfer delays is underscored by several studies reporting that patients arriving at night or on the weekend had higher mortality and increased time to intervention. [19][20][21] However, comprehensive stroke centers have been shown to eliminate the weekend effect in stroke patients. 22 Although teleradiology technologies allowing remote review of medical images have existed for some time, little implementation of these methods has occurred in interhospital transfer.…”

Section: Discussionmentioning

confidence: 98%