Abstract
Outcomes following admission to intensive care units (ICU) may vary with time and day. This study investigated associations between time of day and risk of ICU mortality and chance of ICU discharge in acute ICU admissions. Adult patients (age ≥ 18 years) who were admitted to ICUs participating in the Austrian intensive care database due to medical or surgical urgencies and emergencies between January 2012 and December 2016 were included in this retrospective study. Readmissions were excluded. Statistical analysis was conducted using the Fine-and-Gray proportional subdistribution hazards model concerning ICU mortality and ICU discharge within 30 days adjusted for SAPS 3 score. 110,628 admissions were analysed. ICU admission during late night and early morning was associated with increased hazards for ICU mortality; HR: 1.17; 95% CI: 1.08–1.28 for 00:00–03:59, HR: 1.16; 95% CI: 1.05–1.29 for 04:00–07:59. Risk of death in the ICU decreased over the day; lowest HR: 0.475, 95% CI: 0.432–0.522 for 00:00–03:59. Hazards for discharge from the ICU dropped sharply after 16:00; lowest HR: 0.024; 95% CI: 0.019–0.029 for 00:00–03:59. We conclude that there are “time effects” in ICUs. These findings may spark further quality improvement efforts.
Highlights
Several previously published studies have sought to identify possible effects of “off-hours” admission to both health care facilities in general and intensive care units (ICU)
This study aims to investigate, whether time of day is associated with variation in the risk of ICU mortality and chance of ICU discharge in patients admitted to critical care for medical or surgical emergencies
Applying the previously described exclusion criteria yielded a total of 110,628 patient data sets from 117 ICUs to be analysed in the main analysis
Summary
Several previously published studies have sought to identify possible effects of “off-hours” admission to both health care facilities in general and intensive care units (ICU). This existing body of evidence, does not allow for definitive conclusions on the subject, as these studies lack a common methodological approach and present conflicting results[2,3,4,5,6,7,8,9,10]. The available evidence focuses mainly on a possible association between admission time and outcomes. Extrapolation of findings from studies on “weekend effects” or “off-hour effects” in general supports this assertion[16]
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