Top

Intensive Care Medicine

Published in:

01-05-2004 | Original

Hospital mortality associated with day and time of admission to intensive care units

Authors: Hannah Wunsch, James Mapstone, Tony Brady, Rosa Hanks, Kathryn Rowan

Published in: Intensive Care Medicine | Issue 5/2004

Abstract

Objective

To investigate whether hospital mortality of patients was associated with the day of the week or time of admission to intensive care units (ICUs).

Design

Cohort study.

Setting

One hundred two adult, general (mixed medical/surgical) ICUs in England, Wales and Northern Ireland.

Patients and participants

A total of 56,250 admissions from 1995 to 2000 that fit the inclusion criteria for calculation of the APACHE II probability of hospital mortality.

Interventions

None.

Measurements and results

Crude and case mix adjusted hospital mortality were examined by day of the week and time of day of admission to ICU. Patients admitted on Saturday and Sunday had higher crude hospital mortality compared with admissions on Wednesday [Saturday crude odds ratio (OR) 1.41, 95% CI 1.32–1.52; Sunday OR 1.56, 1.45–1.68]. The association was still significant after adjustment using the UK APACHE II model (Saturday OR 1.16, 1.1.07–1.26; Sunday OR 1.24, 1.14–1.35) but not after adjustment using individual components of the APACHE II model (Saturday OR 1.03, 0.95–1.12; Sunday OR 1.09, 1.00–1.19). Night admissions were also associated with higher mortality compared with day both before and after adjustment for case mix using the UK APACHE II model (crude OR 1.43, 1.37–1.51; adjusted OR 1.16, 1.10–1.23) but not after adjustment using components of the APACHE II model (OR 1.02, 95% CI 0.96–1.09).

Conclusions

After appropriate adjustment for case mix, day of the week and time of day of admission of patients to ICU were not associated with significant differences in hospital mortality.

Carmel S, Rowan K (2001) Variation in intensive care unit outcomes: a search for the evidence on organizational factors. Curr Opin Crit Care 7:284–296CrossRefPubMed

Carson SS, Stocking C, Podsadecki T, Christenson J, Pohlman A, MacRae S, Jordan J, Humphrey H, Siegler M, Hall J (1996) Effects of organizational change in the medical intensive care unit of a teaching hospital: a comparison of “open” and “closed” formats. J Am Med Assoc 276:322–328CrossRef

Blunt MC, Burchett KR (2000) Out-of-hours consultant cover and case-mix-adjusted mortality in intensive care. Lancet 356:735–736CrossRefPubMed

Brown J, Sullivan G (1989) Effect on ICU mortality of a full time critical care specialist. Chest 96:127–129PubMed

Bell CM, Redelmeier DA (2001) Mortality among patients admitted to hospitals on weekends as compared with weekdays. N Engl J Med 345:663–668PubMed

Sheng A, Ellrodt AG, Agocs L, Tankel N, Weingarten S (1993) Is cardiac test availability a significant factor in weekend delays in discharge for chest pain patients? J Gen Intern Med 8:573–575PubMed

Barnett MJ, Kaboli PJ, Sirio CA, Rosenthal GE (2002) Day of the week of intensive care admission and patient outcomes: a multisite regional evaluation. Med Care 40:530–539CrossRefPubMed

Goldfrad C, Rowan K (2000) Consequences of discharges from intensive care at night. Lancet 355:1138–1142PubMed

Sprung CL, Geber D, Eidelman LA, Baras M, Pizov R, Nimrod A, Oppenheim A, Epstein L, Cotev S (1999) Evaluation of triage decisions for intensive care admission. Crit Care Med 27:1073–1079PubMed

10.

Rowan K (1996) Intensive Care Society has set up a centre for national audit. Br Med J 313:1007–1008

11.

Department of Health (2000) Comprehensive Critical Care: a review of adult critical care services

12.

Intensive Care National Audit & Research Centre (ICNARC) (1997). ICNARC Case Mix Programme Dataset Specification, Version 2.0. ICNARC, London

13.

Rowan KM, Black N (2000) A bottom-up approach to performance indicators through clinician networks. Health Care UK:43–46

14.

De Keizer NF, Bonsel GJ, Goldfrad C, Rowan K (2000) The added value that increasing levels of diagnostic information provide in prognostic models to estimate hospital mortality for adult intensive care patients. Intensive Care Med 26:577–584CrossRefPubMed

15.

Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMed

16.

Young JD, Goldfrad C, Rowan (2001) Development and testing of a hierarchical method to code the reason for admission to intensive care units: the ICNARC Coding Method. Br J Anaesth 87:543–548CrossRefPubMed

17.

Bion J (1993) Outcomes in intensive care. Br Med J 307:953–954

18.

Rowan KM, Kerr JH, Major E, McPherson K, Short A, Vessey MP (1993) Intensive Care Society’s APACHE II study in Britain and Ireland-I: variations in case mix of adult admissions to general intensive care units and impact on outcome. Br Med J 307:972–977

19.

Rowan KM, Kerr JH, Major E, McPherson K, Short A, Vessey MP (1993). Intensive Care Society’s APACHE II study in Britain and Ireland-II: outcome comparisons of intensive care units after adjustment for case mix by the American APACHE II method. Br Med J 307:977–981

20.

Rowan KM, Kerr JH, Major E, McPherson K, Short A, Vessey MP (1993) Intensive Care Society’s Acute Physiology and Chronic Health Evaluation (APACHE II) study in Britain and Ireland: a prospective, multicenter, cohort study comparing two methods for predicting outcome for adult intensive care patients. Crit Care Med 22:1392–401

21.

Rowan KM (1992) Outcome comparisons of intensive care units in Great Britain and Ireland using the APACHE II method. Thesis, University of Oxford

22.

Rothman K (1986) Modern epidemiology. Little, Brown and Company, Boston

23.

Cook CH, Martin LC, Howard B, Flancbaum LJ (1999) Survival of critically ill surgical patients discharged to extended care facilities. J Am Coll Surg 189:437–441CrossRefPubMed

24.

Eddleston JM, White P, Guthrie E (2000) Survival, morbidity, and quality of life after discharge from intensive care. Crit Care Med 28:2293–2299

25.

Latour J, Lopez-Camps V, Rodriguez-Serra M, Giner JS, Nolasco A, Alvarez-Dardet C (1990) Predictors of death following ICU discharge. Intensive Care Med 16:125–127PubMed

26.

Luo ZC (2001) Timing of birth and infant and early neonatal mortality in Sweden 1973–1995: longitudinal birth register study. Br Med J 323:1327CrossRef

27.

Paccaud F, Martinberan B, Gutzwiller F (1988) Hour of birth as a prognostic factor for perinatal death. Lancet 1:340–343CrossRefPubMed

28.

Stewart JH, Andrews J, Cartlidge PHT (1998) Numbers of deaths related to intrapartum asphyxia and timing of birth in all Wales perinatal survey, 1993–1995. Br Med J 316:657–660

29.

Fogelholm R, Murros K, Rissanen A, Ilmavirta M (1996) Factors delaying hospital admission after acute stroke. Stroke 27:398–400PubMed

30.

Ottesen MM, Kober L, Jorgensen S, Torp-Pedersen C (1996) Determinants of delay between symptoms and hospital admission in 5978 patients with acute myocardial infarction. Eur Heart J 17:429–437PubMed

31.

Halm EA, Chassin MR (2001) Why do hospital death rates vary? N Engl J Med 345:692–694CrossRefPubMed

32.

Lemeshow S, Teres D, Klar J, Spitz-Avrunin J, Gehlbach SH, Rapoport J (1993) Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. J Am Med Assoc 270:2478–2486CrossRef

33.

Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. J Am Med Assoc 270:2957–2963CrossRef

34.

Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, Sirio CA, Murphy DJ, Lotring T, Damiano A, Harrell Jr FE (1991) The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100:1619–1636PubMed

35.

Markgraf R, Deutschinoff G, Pientka L, Scholten T, Lorenz C (2001) Performance of the score systems Acute Physiology and Chronic Health Evaluation II and III at an interdisciplinary intensive care unit, after customization. Crit Care 5:31–36

36.

Mourouga P, Goldfrad C, Rowan K (2000) Does it fit? Is it good? Assessment of scoring systems. Curr Opin Crit Care 6:176–180CrossRef

Title: Hospital mortality associated with day and time of admission to intensive care units
Authors: Hannah Wunsch
James Mapstone
Tony Brady
Rosa Hanks
Kathryn Rowan
Publication date: 01-05-2004
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 5/2004
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-004-2170-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Hospital mortality associated with day and time of admission to intensive care units

Abstract

Objective

Design

Setting

Patients and participants

Interventions

Measurements and results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Setting

Patients and participants

Interventions

Measurements and results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2004

Increased diffusion of soluble adhesion molecules in meningitis, severe sepsis and systemic inflammatory response without neurological infection is associated with intrathecal shedding in cases of meningitis

Plasma and lung concentrations of ceftazidime administered in continuous infusion to critically ill patients with severe nosocomial pneumonia

Challenges in end-of-life care in the ICU

Myocardial redox state during coronary artery bypass grafting assessed with microdialysis

Non-invasive negative and positive pressure ventilation in the treatment of acute on chronic respiratory failure

Stress-hyperglycemia, insulin and immunomodulation in sepsis