Off hour admission to an intensivist-led ICU is not associated with increased mortality

Meynaar, Iwan A.; Spoel, J. I. van der; Rommes, Johannes H.; Spreuwel-Verheijen, M Van; Bosman, Rob J.; Spronk, Peter E.

doi:10.1186/cc7904

Cited by 61 publications

(62 citation statements)

References 18 publications

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“…However, in one recent study, out-of-hours admissions to three intensive care units were found to have higher illness severity, as measured by APACHE II and SAPS II scores, and this was associated with increased mortality. 17 In our cohort, patients admitted at the weekend who survived the first seven days do not have a higher subsequent mortality rate, but those admitted on Monday take days, at night or out of hours do appear to have a worse outcome even if they survive the first seven days. We postulate that these differences in late mortality are more likely to be explained by variation in initial illness severity, since any in-hospital factors around the time of admission would be expected to have less impact after seven days.…”

Section: Patient and Pre-hospital Factorsmentioning

confidence: 61%

Mortality in out-of-hours emergency medical admissions – more than just a weekend effect

Maggs¹,

Mallet²

2010

JRCPE

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Mortality among emergency medical admissions to hospital is higher for admissions at the weekend than on weekdays; this also holds true for certain specific conditions. However, it is unknown whether that effect is limited to weekends. This study calculated mortality in emergency medical admissions for each day of the week, and compared mortality at weekends with weekdays, at nights with days, and in all out-of-hours periods with in-hours in a UK district general hospital. Total mortality was increased for admissions on Mondays, at night, and in all out-of-hours periods; late in-hospital mortality (after seven days) remained increased when the initial admission occurred on Mondays, at night or out of hours. It is likely that illness severity as well as resource and organisational factors are involved.

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Section: Patient and Pre-hospital Factorsmentioning

confidence: 61%

Mortality in out-of-hours emergency medical admissions – more than just a weekend effect

Maggs¹,

Mallet²

2010

JRCPE

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“…7 Beyond the impact of discharge day, evidence from a variety of areas of clinical medicine suggests that the day of the week on which medical care is provided may have a significant impact on health outcomes. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] For patients undergoing elective inpatient surgery, there is evidence that the risk of mortality differs between days of the work week. In the United Kingdom, each day following Monday was associated with an independent increase in the odds of 30-day mortality, with a marked relative increase (compared with Monday) of 44% on Friday and 82% on weekend days.…”

Section: Résumémentioning

confidence: 99%

Impact of ambulatory surgery day of the week on postoperative outcomes: a population-based cohort study

McIsaac

Bryson

Walraven

2015

Can J Anesth/J Can Anesth

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Purpose Ambulatory surgery is generally considered safe; however, as many as 3% of patients require unplanned acute postoperative care. The purpose of this study was to measure the impact of the day of the week of surgery on the outcomes of ambulatory surgery. Methods Using population-based health administrative data, we conducted a historical cohort analysis by identifying patients who underwent ambulatory surgery from 2002-2012. Multivariable regression was used to measure the association between the day of the week of surgery and the primary outcomes of 30-day emergency department (ED) visit or hospital readmission after successful discharge on the day of surgery. The secondary outcome that was similarly compared was unsuccessful discharge on the day of surgery. Results Of 296,497 patients identified, 32,100 (10.5%) returned to the ED or were readmitted to hospital within 30 days. Adjusting for demographics, comorbidities, and preoperative use of health resources, Friday surgery was most associated with the primary outcome (adjusted hazard ratio, 1.07; 95% confidence interval, 1.03 to 1.11) when compared with Monday surgery. This association was stronger in certain surgery types. There were 9,197 (3.1%) patients who were not discharged on the day of surgery; no association between day of the week and unsuccessful discharge was identified. Conclusion On a population level, there was a small effect of the day of the week of ambulatory surgery on outcomes; however, the clinical impact is likely not relevant. Certain surgical types may be more susceptible to a day of the week effect, but more research is needed to elucidate this notion. RésuméObjectif En règle générale, les chirurgies ambulatoires sont considérées comme étant sécuritaires; toutefois, jusqu'à 3 % des patients nécessitent des soins postopératoires aigus non planifiés. L'objectif de cette étude était de mesurer l'impact du jour de la semaine durant lequel la chirurgie a eu lieu sur les pronostics de chirurgie ambulatoire. Méthode À l'aide des données administratives de santé basées sur la population, nous avons réalisé une analyse de cohorte historique en identifiant les patients ayant subi une chirurgie ambulatoire entre 2002 et 2012. Nous avons utilisé une analyse par régression multivariée pour mesurer l'association entre le jour de la semaine au

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“…These are especially important in the 'off hours' (4:00 PM to 08:00 AM and the weekend) in the ICU [26]. In one study, the authors stated that implementation of the weaning process on weekends shortened sedation usage and IMV duration [27].…”

Section: Discussionmentioning

confidence: 99%

Full-Time ICU Staff in the Intensive Care Unit: Does It Improve the Outcome?

Adıgüzel¹,

Karakurt²,

Moçin³

et al. 2015

Tur Toraks Der

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OBJECTIVES:Patients with various severities are cared for in the intensive care unit (ICU) by an experienced ICU physician. We aimed to assess whether there is any difference in intubated ICU patient management when undertaken by a 24-hour intensivist versus a periodic experienced specialist in the ICU. MATERIAL AND METHODS:A retrospective, cross-sectional, observational study was done in a tertiary teaching hospital ICU. Patients receiving invasive mechanical ventilation (IMV) were classified into: group 1, managed by an experienced ICU pulmonary specialist during night shifts in 2006-2007, and group 2, managed by an intensivist around the clock in 2011. Patients were excluded if they were <18 years old, tracheostomized, or transferred from another ICU. Patient demographics and ICU data (IMV duration, sedation doses and duration, weekend extubation, ICU severity score [APACHE II], length of ICU stay, and mortality) were recorded, and groups were compared. RESULTS:In group 1, 131 of 215 IMV patients were included in the study, and in group 2, 294 of 374 patients were included. The sedation infusion rate, duration of IMV, self-extubation rate, and lenght of stay (LOS) of ICU were significantly increased in group 1 compared with group 2 (72.5% vs. 40.8%, p<0.0001; 152 vs. 68 hours, p<0.001; 24.4% vs. 13.9%, p<0.006; 13 vs. 8 days, p<0.0001, respectively). The weekend extubation rate and APACHE II scores were significantly lower in group 1 compared with group 2 (7.1% vs. 25.3%, p<0.0001; 22 vs. 25, p<0.017, respectively). Mortality rates were similar in the two groups (35.9% vs. 37.4%, p=0.76). CONCLUSION:A 24-hour intensivist appears to be better for decreasing IMV duration and LOS in the ICU. These results may be useful to address decreasing morbidity and, as a result, cost of ICU stays by 24-hour intensivist coverage, especially for patients with IMV. KEY WORDS:Twenty-four-hour intensivist, length of ICU stay, mortality INTRODUCTIONThe intensive care unit (ICU) is available 24 hours a day, 7 days a week (24/7) for admission of critically ill patients. The importance of the 'golden' hours for initial assessment and timely management of critically ill patients in the ICU is well known. The 24-hour availability of an intensivist may result in more prompt and accurate diagnostic evaluation and appropriate therapeutic decisions.The models of organization and management of ICUs are different in several countries, and even from hospital to hospital, there is a large difference with respect to training [1]. There is a controversial approach to mandatory 24-hour versus on-demand intensivist staffing [2,3].Several studies suggest that an around-the-clock intensivist improves ICU outcomes with respect to decreased morbidity and mortality [4][5][6][7][8]. However, this around-the-clock intensivist model is expensive due to the shortage of intensivists [9][10][11], although it has been shown to be better for the intensivist with respect to decreasing 'burnout' [12]. We proposed that this model might be more relevant in intub...

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Off hour admission to an intensivist-led ICU is not associated with increased mortality

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.

Cited by 61 publications

References 18 publications

Mortality in out-of-hours emergency medical admissions – more than just a weekend effect

Mortality in out-of-hours emergency medical admissions – more than just a weekend effect

Impact of ambulatory surgery day of the week on postoperative outcomes: a population-based cohort study

Full-Time ICU Staff in the Intensive Care Unit: Does It Improve the Outcome?

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