Intensive Care Medicine

, Volume 34, Issue 1, pp 148–151

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

  • Andrew Numa
  • Gary Williams
  • John Awad
  • Barry Duffy
Pediatric Original

DOI: 10.1007/s00134-007-0904-8

Cite this article as:
Numa, A., Williams, G., Awad, J. et al. Intensive Care Med (2008) 34: 148. doi:10.1007/s00134-007-0904-8

Abstract

Objective

To examine the influence of time of admission on risk-adjusted mortality and length of stay for nonelective patients admitted to a pediatric intensive care unit (ICU) without 24-h per day in-house intensivist coverage.

Design

Data analyzed came from a comprehensive, prospectively collected ICU database.

Setting

A 12-bed pediatric ICU located in a university-affiliated tertiary referral children's hospital.

Patients

Subjects consisted of 4,456 consecutive nonelective patients admitted over a 10-year period (1997–2006).

Interventions

None.

Measurements and results

Patients were categorized according to time of admission to the ICU as either in-hours (0800–1800 Monday–Friday and 0800–1200 on weekends), when an intensivist is present in the ICU, or after-hours (all other times), when intensivists attend only on an as-needed basis. Multivariate logistic regression was used to assess the effect of time of admission on outcome after adjustment for severity of illness using the Paediatric Index of Mortality (PIM). Patients admitted after hours had a lower risk-adjusted mortality than those admitted during normal working hours, with an odds ratio for death of 0.712 (95% confidence interval 0.518–0.980, p = 0.037). Length of stay was also significantly shorter for patients admitted after hours (44.05 h vs. 50.0 h, p = 0.001).

Conclusions

A lack of in-house intensivist presence is not associated with any increase in mortality or length of stay for patients admitted to our pediatric ICU; on the contrary, after-hours admission in this cohort was associated with a decreased risk-adjusted mortality and a shorter length of stay.

Keywords

MortalityPediatricOutcomesIntensive careLength of stayQuality

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Andrew Numa
    • 1
    • 2
  • Gary Williams
    • 1
    • 2
  • John Awad
    • 1
    • 2
  • Barry Duffy
    • 1
    • 2
  1. 1.Intensive Care UnitSydney Children’s HospitalRandwickAustralia
  2. 2.University of New South WalesSydneyAustralia