Mortality associated with timing of admission to and discharge from ICU: a retrospective cohort study

Laupland, Kevin B., Misset, Benoit, Souweine, Bertrand, Tabah, Alexis, Azoulay, Elie, Goldgran-Toledano, Dany, Dumenil, Anne-Sylvie, Vesin, Aurelien, Jamali, Samir, Kallel, Hatem, Clec'h, Christophe, Darmon, Michael, Schwebel, Carole and Timsit, Jean-Francois (2011) Mortality associated with timing of admission to and discharge from ICU: a retrospective cohort study. BMC Health Services Research, 11 . doi:10.1186/1472-6963-11-321

Author Laupland, Kevin B.
Misset, Benoit
Souweine, Bertrand
Tabah, Alexis
Azoulay, Elie
Goldgran-Toledano, Dany
Dumenil, Anne-Sylvie
Vesin, Aurelien
Jamali, Samir
Kallel, Hatem
Clec'h, Christophe
Darmon, Michael
Schwebel, Carole
Timsit, Jean-Francois
Title Mortality associated with timing of admission to and discharge from ICU: a retrospective cohort study
Journal name BMC Health Services Research   Check publisher's open access policy
ISSN 1472-6963
Publication date 2011-11-24
Year available 2011
Sub-type Article (original research)
DOI 10.1186/1472-6963-11-321
Open Access Status DOI
Volume 11
Total pages 8
Place of publication London, United Kingdom
Publisher BioMed Central
Language eng
Formatted abstract
Background: Although the association between mortality and admission to intensive care units (ICU) in the "after hours" (weekends and nights) has been the topic of extensive investigation, the timing of discharge from ICU and outcome has been less well investigated. The objective of this study was to assess effect of timing of admission to and discharge from ICUs and subsequent risk for death.

Methods: Adults (18 years) admitted to French ICUs participating in Outcomerea between January 2006 and November 2010 were included.

Results: Among the 7,380 patients included, 61% (4,481) were male, the median age was 62 (IQR, 49-75) years, and the median SAPS II score was 40 (IQR, 28-56). Admissions to ICU occurred during weekends (Saturday and Sunday) in 1,708 (23%) cases, during the night (18:00-07:59) in 3,855 (52%), and on nights and/or weekends in 4,659 (63%) cases. Among 5,992 survivors to ICU discharge, 903 (15%) were discharged on weekends, 659 (11%) at night, and 1,434 (24%) on nights and/or weekends. After controlling for a number of co-variates using logistic regression analysis, admission during the after hours was not associated with an increased risk for death. However, patients discharged from ICU on nights were at higher adjusted risk (odds ratio, 1.54; 95% confidence interval, 1.12-2.11) for death.

Conclusions: In this study, ICU discharge at night but not admission was associated with a significant increased risk for death. Further studies are needed to examine whether minimizing night time discharges from ICU may improve outcome.
Keyword Health Care Sciences & Services
Health Care Sciences & Services
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 18 times in Thomson Reuters Web of Science Article | Citations
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