Impact of Admission Time on Mortality in an Indian Intensive Care Unit With Round-the-Clock Intensivist Coverage

Abstract

Higher mortality in patients admitted during off hours has been attributed to inadequate staffing, but only a few studies have assessed the impact of 24-hour intensivist coverage on ICU mortality. We aimed to assess the impact of admission time on mortality for patients admitted to an ICU with 24-hour in-house intensivist coverage through a retrospective study analyzing data from all admissions to a medical ICU over 15 months. Patients were divided into 2 groups by time of ICU admission: regular hours (Monday-Saturday 9 am to 5 pm) and off hours (Monday-Saturday 5 pm to 9 am, Sunday). Patients were compared with regard to demographics, severity of illness, ICU course, and ICU outcome. Primary outcome measure was ICU mortality. Of 653 admissions, 391 (59.9%) were admitted during off hours. There was no significant difference in age, sex, severity of illness, need for organ support, and ICU stay. ICU mortality was 14.9% and 16.4% in regular and off hours, respectively ( P = .689). Relative risk of death for admission in after hours was 1.018 (95% CI, 0.952-1.088), with the odds ratio of dying being 1.119 (95% CI, 0.726-1.726). We concluded that full-time intensivist coverage ensures continuity of care. Hence, off-hour admissions may not be associated with any increased mortality.