Off-hours admission and mortality in two pediatric intensive care units without 24-h in-house senior staff attendance

Abstract

PurposeTo compare risk-adjusted mortality of children non-electively admitted during off-hours with risk-adjusted mortality of children admitted during office hours to two pediatric intensive care units (PICUs) without 24-h in-house attendance of senior staff.DesignProspective observational study, performed between January 2003 and December 2007, in two PICUs without 24-h in-house attendance of senior staff, located in tertiary referral children’s hospitals in the Netherlands.MethodsStandardized mortality rates (SMRs) of patients admitted during off-hours were compared to SMRs of patients admitted during office hours using Pediatric Index of Mortality (PIM1) and Pediatric Risk of Mortality (PRISM2) scores. Office hours were defined as week days between 8:00 a.m. and 6:00 p.m., with in-house attendance of senior staff, and off-hours as week days between 6:00 p.m. and 8:00 a.m., Saturdays, Sundays and public holidays, with one resident covering the PICU and senior staff directly available on-call.ResultsOf 3,212 non-elective patients admitted to the PICUs, 2,122 (66%) were admitted during off-hours. SMRs calculated according to PIM1 and PRISM2 did not show a significant difference with those of patients admitted during office hours. There was no significant effect of admission time on mortality in multivariate logistic regression with odds ratios of death in off-hours of 0.95 (PIM1, 95% CI 0.71–1.27, p = 0.73) and 1.03 (PRISM2, 95% CI 0.76–1.39, p = 0.82).ConclusionOff-hours admission to our PICUs without 24-h in-house attendance of senior staff was not associated with higher SMRs than admission during office hours when senior staff were available in-house.

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

“…Moreover, a second senior staff member was available to perform transfers or manage in-hospital emergencies. 26 These data might increase interest in adequate intensivist staffi ng when patients' conditions are most severe, whatever the time of the day. 27 A medical organization clearly defi ned and adapted to ICU activity would protect patients at a disadvantage for care due to their time of admission.…”

“…13 A recent study in a pediatric ICU showed that night and weekend admissions without 24-hour, in-house, senior staff attendance was not associated with a higher mortality as compared with the daytime admissions when the senior staff were available in house. 26 However, a pediatric intensivist was able to quickly report to the pediatric ICU to care for all unstable patients and personally supervise admissions and all critical procedures, such as endotracheal intubation or catheter insertion. Moreover, a second senior staff member was available to perform transfers or manage in-hospital emergencies.…”

Perfil de mortalidad en una Unidad de Cuidados Intensivos Pediátricos: asociación entre la mortalidad y el período fuera del horario diurno semanal

“…11 En varios estudios llevados a cabo en Turquía, Estados Unidos, Australia, Italia e Inglaterra, se demostró que el ingreso a la UCIP fuera del horario con médicos de planta no aumentó la mortalidad, mientras que el ingreso de los pacientes fuera de ese horario mostró una relación con una disminución de la mortalidad en un estudio en un solo centro realizado en Australia. [8][9][10][11][12] En un estudio de Italia, la ausencia de una persona a cargo durante las 24 horas en la unidad no afectó la mortalidad. 9 En nuestro estudio, se analizó el horario de la muerte en los pacientes que fallecieron en la UCIP dentro y fuera del horario diurno con la presencia de un médico de planta.…”

“…[8][9][10][11][12] En un estudio de Italia, la ausencia de una persona a cargo durante las 24 horas en la unidad no afectó la mortalidad. 9 En nuestro estudio, se analizó el horario de la muerte en los pacientes que fallecieron en la UCIP dentro y fuera del horario diurno con la presencia de un médico de planta. No obstante, si bien los estudios encontrados en la bibliografía investigaron, en su mayoría, la influencia del horario de ingreso a la UCIP sobre la mortalidad, en nuestro estudio se analizó la relación con el horario del fallecimiento.…”

“…6 Según los estudios disponibles, la mortalidad es mayor durante las hospitalizaciones nocturnas. 7 En algunos estudios, se indica que el ingreso fuera del turno diurno no aumentaría la mortalidad [8][9][10] y que el ingreso después del turno diurno estaría asociado con una reducción de la mortalidad. 11 Sin embargo, la cantidad de estudios que evaluaron los resultados de los pacientes hospitalizados en la UCIP son limitados.…”