Systems-Based Practice/InvestigationHospital mortality among adults admitted to and discharged from intensive care on weekends and evenings☆
Introduction
Several studies conducted in a number of different populations indicate that patients admitted to hospitals on weekends and evenings have a higher mortality rate [1], [2], [3], [4], [5], [6], [7]. Many factors have been proposed to explain these observations including lower levels of staffing and restricted availability of tests and procedures during these times. In addition, patients admitted “after hours” may be intrinsically at higher risk for death by virtue of a different case mix or increased severity of illness as compared with patients admitted during usual business hours. As a result of their acuity and severity of illness, patients admitted to intensive care units (ICU) represent a distinct in-hospital population. Although the body of literature is limited, studies conducted in critically ill populations have largely demonstrated higher crude mortality rates associated with admission during weekends and evenings [8], [9], [10], [11], [12], [13], [14]. However, in many cases, no increased risk associated with off-hours admission was present after controlling for confounding factors [8], [10], [12], [13]. Similarly to off-hours admissions, weekend and evening discharge from ICU has also been associated with increased mortality risk [15], [16], [17].
If admission to or discharge from ICU after hours and/or on weekends truly increases the risk for an adverse outcome, then a major safety and process of care issue is present that requires attention. A relatively small number of studies have specifically looked at the effect of admission timing and outcome in adult ICUs, and even fewer have assessed the effect of timing of discharge. We undertook the present study to explore the effect that timing of admission to and discharge from ICU may have on mortality outcome.
Section snippets
Study population
The Calgary Health Region (CHR) provides virtually all acute hospital care to the residents of the cities of Calgary and Airdrie and a large surrounding area (population, 1.2 million) in the Province of Alberta, Canada. Critically ill adult patients in the CHR are managed in closed ICUs under the care of the Department of Critical Care Medicine, University of Calgary and CHR. These currently include a 14-bed cardiovascular surgery ICU (CVICU) and 3 multisystem ICUs: one 24-bed multisystem ICU
Results
During the 7-year study period, a total of 24 204 ICU admissions occurred among 20 466 adult patients. Sixty-four percent (13 119) of patients were male, the median age was 63.7 years (IQR, 49.9-73.8 years), and the mean ± SD APACHE II score was 25.1 ± 8.48 (n = 20 338). Intensive care unit admissions occurred during weekends (Saturday and Sunday) in 3715 (18%) cases, during the night (6:00 PM -7:59) in 8450 (41%), and on nights and/or weekends in 9987 (49%) cases. Among 17 864 survivors to ICU
Discussion
After controlling for a number of covariates, we found that, although there is no evidence of a “weekend effect,” patients admitted after hours are at increased risk for death. A number of investigators have observed increased risk for mortality associated with ICU admission on weekends, but this excess mortality has largely been explained by increased rates of admission of sicker patients or those with a different case mix [8], [9], [10], [11], [12], [13]. Although we adjusted for a number of
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No external funding was received for this study. None of the authors have financial or professional conflicts of interest that would influence the conduct or reporting of this study.