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Association between ICU admission during morning rounds and mortality
Bekele Afessa1, Ognjen Gajic1, Ian J Morales1
1Division of Pulmonary and Critical Care Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Insights
Patients admitted to the intensive care unit (ICU) during morning rounds face higher mortality risks. This study found round-time ICU admission is an independent risk factor for hospital death, highlighting potential care disparities.
Area of Science:
- Critical Care Medicine
- Hospital Administration
- Patient Outcomes Research
Background:
- No prior research has investigated the link between intensive care unit (ICU) admission timing during morning rounds and patient outcomes.
- Understanding this association is crucial for optimizing patient care and resource allocation within critical care settings.
Purpose of the Study:
- To investigate the relationship between intensive care unit (ICU) admission during morning rounds and patient outcomes.
- To identify if admission timing influences severity of illness and mortality rates in ICU patients.
Main Methods:
- Retrospective analysis of 49,844 patients admitted to four ICUs (surgical, medical, multispecialty) between 1994 and 2007.
- Comparison of patients admitted during round time (8:00-10:59 am) versus non-round time (1:00 pm - 6:00 am).
- Utilized data from the Acute Physiology and Chronic Health Evaluation (APACHE) III database to assess patient characteristics and outcomes.
Main Results:
- Patients admitted during round time exhibited a higher predicted hospital mortality rate (17.4% vs. 12.3%) and actual mortality rate (16.2% vs. 8.8%).
- Round-time ICU admission was identified as an independent risk factor for hospital death (OR, 1.321), particularly in the medical ICU.
- This association persisted throughout the study period, except for the final two years when the medical ICU had 24/7 intensivist coverage.
Conclusions:
- Intensive care unit (ICU) admissions occurring during morning rounds are associated with increased patient severity of illness and higher mortality rates.
- The findings suggest that timing of ICU admission, potentially related to staffing or handover processes, impacts patient outcomes.
Background:
No previous study has evaluated the association between admission to ICUs during round time and patient outcome. The objective of this study was to determine the association between round-time ICU admission and patient outcome.
Methods:
This retrospective study included 49,844 patients admitted from October 1994 to December 2007 to four ICUs (two surgical, one medical, and one multispecialty) of an academic medical center. Of these patients, 3,580 were admitted to the ICU during round time (8:00 am to 10:59 am) and 46,264 were admitted during nonround time (from 1:00 pm to 6:00 am). The medical ICU had 24-h/7-day per week intensivist coverage during the last 2 years of the study. We compared the baseline characteristics and outcome of patients admitted to the ICU between the two groups. Data were abstracted from the acute physiology and chronic health evaluation (APACHE) III database.
Results:
The round-time and non-round-groups were similar in gender, ethnicity, and age. The predicted hospital mortality rate of the round time group was higher (17.4% vs 12.3% predicted, respectively; p < 0.001). The hospital length of stay was similar between the two groups. The round-time group had a higher hospital mortality rate (16.2% vs 8.8%, respectively; p < 0.001). Most of the round-time ICU admissions and deaths occurred in the medical ICU. Round-time admission was an independent risk factor for hospital death (odds ratio, 1.321; 95% CI, 1.178 to 1.481). This independent association was present for the whole study period except for the last 2 years.
Conclusions:
Patients admitted to the ICU during morning rounds have higher severity of illness and mortality rates.
