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Do weekends or evenings matter in a pediatric intensive care unit?
Eric D Hixson1, Steve Davis, Sarah Morris
1From the Quality Institute, Cleveland Clinic Health System, Cleveland, OH, USA.
Summary
Weekend or evening admissions to a pediatric intensive care unit (PICU) do not independently impact mortality when 24/7 intensivist staffing is in place. This study found no significant effect after controlling for clinical factors.
Area of Science:
- Pediatric Critical Care Medicine
- Healthcare Quality and Safety
- Medical Outcomes Research
Background:
- Pediatric intensive care units (PICUs) aim to provide continuous, high-level care.
- Concerns exist regarding potential variations in care quality and outcomes based on admission timing (e.g., weekends, evenings).
- The impact of admission timing on mortality in PICUs with 24/7 in-house intensivist coverage requires investigation.
Purpose of the Study:
- To determine if weekend or evening admission to a pediatric intensive care unit (PICU) independently affects patient mortality.
- To assess the influence of admission timing on mortality in a PICU with 24/7 board-certified intensivist staffing.
Main Methods:
- Retrospective analysis of 5,968 consecutive PICU admissions (0-21 years) from August 1996 to December 2003.
- Multivariate logistic regression used to analyze the independent effect of weekend/evening admission and discharge/death on mortality.
- Analysis conducted on the entire sample and a subset of emergency admissions, controlling for covariates.
Main Results:
- Crude mortality was higher for weekend (5.0%) and evening (3.8%) admissions compared to weekday (2.2%) and daytime (2.1%) admissions.
- Multivariate analysis revealed no significant independent effect of weekend admission, weekend discharge/death, or evening admission on mortality in the entire sample or emergency subset.
- Significant clinical differences were observed between weekend/evening and weekday/daytime admissions, including higher likelihood of emergency, nonoperative cases and differing diagnostic distributions.
Conclusions:
- Weekend or evening admission does not independently influence mortality risk in a PICU with 24/7 intensivist coverage, after accounting for clinical factors.
- Findings support the effectiveness of continuous, in-house intensivist staffing in mitigating risks associated with admission timing.
- Simple comparisons of crude mortality rates are insufficient due to underlying clinical differences in patient populations admitted at different times.