An examination of cardiovascular intensive care unit mortality based on admission day and time
Matthew C Langston1, Keshab Subedi2, Carly Fabrizio3
1Department of Medicine, ChristianaCare Health System, Newark, DE, United States.
Insights
Weekend admissions to cardiovascular intensive care units (CICUs) are linked to higher patient mortality. This study highlights potential disparities in care during off-hours, emphasizing the need for consistent staffing and care models.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Health Services Research
Background:
- The 'weekend effect' in healthcare, particularly in cardiovascular intensive care units (CICUs), warrants further investigation.
- The impact of off-hours admission on patient mortality and length of stay in CICUs remains unclear.
Purpose of the Study:
- To analyze the association between cardiovascular intensive care unit (CICU) admission day and time with patient mortality.
- To evaluate the relationship between CICU admission time and patient length of stay.
Main Methods:
- A retrospective cohort study of 10,638 adult patients admitted to a tertiary-care academic medical center's CICU.
- Analysis of ICU mortality and length of stay based on admission day and time, adjusting for comorbidities and clinical variables.
- Logistic regression and generalized linear models (GLM) were used for statistical analysis.
Main Results:
- Weekend-day admissions were associated with increased mortality for all patients (OR: 1.32) and medical CICU admissions (OR: 1.35).
- Weekday-night admissions showed a 7% longer ICU length of stay in surgical CICU patients but a 7% shorter stay in medical CICU patients.
Conclusions:
- Admission to an open-model CICU during weekend hours is linked to higher mortality compared to weekday or night admissions.
- ICU care models should maintain consistent staffing and quality regardless of the day of the week.
Background:
Recent interest in the 'weekend effect' has been expanded to cardiovascular intensive care units, yet the impact of off-hours admission on mortality and cardiovascular ICU (CICU) length of stay remains uncertain.
Objectives:
We examine the association between CICU admission day and time with mortality. Additionally, length-of-stay was also evaluated in relation to admission time.
Methods:
A single-center, retrospective cohort study was conducted including 10,638 adult patients admitted to a CICU in a tertiary-care academic medical center from July 1, 2012 to June 30, 2019. ICU mortality and length-of-stay were assessed by admission day and time adjusting for comorbid conditions and other clinical variables. We used logistic regression models to evaluate the factors associated with mortality and a generalized linear model (GLM) with log link function and gamma distribution was used to evaluate the factors associated with ICU length of stay.
Results:
Compared to weekday-day admissions, we observed an increased mortality for weekend-day for all admissions (6.5 vs 9.6%, Adjusted OR: 1.32 (1.03-1.72)), and for medical CICU admissions (7.6 vs 9.9%, Adjusted OR: 1.35 (1.02-1.79)). Additionally, compared to weekday-day, weekday-night admission was associated with 7% longer ICU length of stay in surgical ICU patients, 7% shorter length of stay in medical ICU patients.
Conclusion:
Admission to this open-model CICU during weekend hours (Saturday 08:00-Sunday 17:59) versus nights or weekdays is associated with increased mortality. ICU staffing care models should not significantly change based on the day of the week.
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