Hospital mortality is associated with ICU admission time

Hans A.J.M. Kuijsten, Sylvia Brinkman, Iwan A. Meynaar, Peter E. Spronk, Johan I. Van Der Spoel, Rob J. Bosman, Nicolette F. De Keizer, Ameen Abu-Hanna, Dylan W. De Lange

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Abstract

Introduction: Previous studies have shown that patients admitted to the intensive care unit (ICU) after "office hours" are more likely to die. However these results have been challenged by numerous other studies. We therefore analysed this possible relationship between ICU admission time and in-hospital mortality in The Netherlands. Methods: This article relates time of ICU admission to hospital mortality for all patients who were included in the Dutch national ICU registry (National Intensive Care Evaluation, NICE) from 2002 to 2008. We defined office hours as 08:00-22:00 hours during weekdays and 09:00-18:00 hours during weekend days. The weekend was defined as from Saturday 00:00 hours until Sunday 24:00 hours. We corrected hospital mortality for illness severity at admission using Acute Physiology and Chronic Health Evaluation II (APACHE II) score, reason for admission, admission type, age and gender. Results: A total of 149,894 patients were included in this analysis. The relative risk (RR) for mortality outside office hours was 1.059 (1.031-1.088). Mortality varied with time but was consistently higher than expected during "off hours" and lower during office hours. There was no significant difference in mortality between different weekdays of Monday to Thursday, but mortality increased slightly on Friday (RR 1.046; 1.001-1.092). During the weekend the RR was 1.103 (1.071-1.136) in comparison with the rest of the week. Conclusions: Hospital mortality in The Netherlands appears to be increased outside office hours and during the weekends, even when corrected for illness severity at admission. However, incomplete adjustment for certain confounders might still play an important role. Further research is needed to fully explain this difference.

Original languageEnglish
Pages (from-to)1765-1771
Number of pages7
JournalIntensive Care Medicine
Volume36
Issue number10
DOIs
Publication statusPublished - 1 Oct 2010

Cite this

Kuijsten, H. A. J. M., Brinkman, S., Meynaar, I. A., Spronk, P. E., Van Der Spoel, J. I., Bosman, R. J., ... De Lange, D. W. (2010). Hospital mortality is associated with ICU admission time. Intensive Care Medicine, 36(10), 1765-1771. https://doi.org/10.1007/s00134-010-1918-1