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Med J Aust. 2011 Mar 21;194(6):287-92.

Increased mortality associated with after-hours and weekend admission to the intensive care unit: a retrospective analysis.

Author information

  • 1Liverpool Hospital, Sydney, NSW, Australia. deepak@unsw.edu.au

Erratum in

  • Med J Aust. 2011 Apr 4;194(7):376.

Abstract

OBJECTIVE:

To study variation in mortality associated with time and day of admission to the intensive care unit (ICU).

DESIGN:

Retrospective cohort analysis using the Australian and New Zealand Intensive Care Society Adult Patient Database.

SETTING AND PARTICIPANTS:

245,057 admissions to 41 Australian ICUs from January 2000 to December 2008.

MAIN OUTCOME MEASURES:

Observed mortality and standardised mortality ratio (SMR) based on Acute Physiology and Chronic Health Evaluation III, 10th iteration (APACHE III-j) scores. Subgroup analysis was performed on the basis of elective surgical or emergency admission to ICU.

RESULTS:

48% of patients were admitted after hours (18:00-05:59) and 20% of patients were admitted on weekends (Saturday and Sunday). Patients admitted after hours had a 17% hospital mortality rate compared with 14% of patients admitted in hours (P < 0.001); and SMRs of 0.92 (95% CI, 0.91-0.93) and 0.83 (95% CI, 0.83-0.84), respectively. Weekend admissions had a 20% hospital mortality rate compared with 14% on weekdays (P < 0.001), with SMRs of 0.95 (95% CI, 0.94-0.97) and 0.92 (95% CI, 0.92-0.93), respectively. Variation in outcome with time of admission to ICU was accounted for predominantly by elective surgical patients.

CONCLUSIONS:

Patients admitted to ICUs in Australia after hours and on weekends have a higher observed and risk-adjusted mortality than patients admitted at other times. Further research is required to determine the causes and relationship to resource availability and staffing.

PMID:
21426282
[PubMed - indexed for MEDLINE]
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