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After-hours admissions are not associated with increased risk-adjusted mortality in pediatric intensive care

Andrew Numa1, Gary Williams, John Awad

  • 1Intensive Care Unit, Sydney Children's Hospital, High St., 2031, Randwick, Australia. A.Numa@unsw.edu.au

Intensive Care Medicine
|October 19, 2007
PubMed

Insights

Patients admitted to a pediatric intensive care unit (ICU) after hours had lower risk-adjusted mortality and shorter lengths of stay. This finding suggests that 24-hour intensivist coverage may not be necessary for all pediatric ICU patients.

Area of Science:

  • Pediatric critical care medicine
  • Healthcare management

Background:

  • Pediatric intensive care units (PICUs) often lack 24-hour in-house intensivist coverage.
  • Assessing the impact of admission timing on patient outcomes is crucial for resource allocation and quality improvement.

Purpose of the Study:

  • To investigate the effect of admission time on risk-adjusted mortality and length of stay in a pediatric intensive care unit (PICU).
  • To evaluate outcomes for nonelective patients admitted to a PICU without continuous intensivist presence.

Main Methods:

  • Analysis of a prospectively collected PICU database.
  • Inclusion of 4,456 consecutive nonelective admissions over a 10-year period (1997-2006).
  • Comparison of outcomes for 'in-hours' versus 'after-hours' admissions using multivariate logistic regression, adjusted for illness severity (Paediatric Index of Mortality).

Main Results:

  • After-hours admissions were associated with significantly lower risk-adjusted mortality (odds ratio 0.712, P=0.037).
  • Patients admitted after hours had a shorter length of stay (44.05 hours vs. 50.0 hours, P=0.001).

Conclusions:

  • Lack of 24-hour in-house intensivist coverage was not linked to increased mortality or length of stay in this PICU.
  • After-hours admission in this cohort correlated with improved outcomes, including decreased mortality and shorter hospital stays.
Abstract

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