Intensive Care Medicine

, Volume 34, Issue 1, pp 148–151 | Cite as

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

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

Mortality Pediatric Outcomes Intensive care Length of stay Quality 

References

  1. 1.
    Havill JH (2006) Resident consultants in large intensive care units—the way of the future. Crit Care Resusc 8:7PubMedGoogle Scholar
  2. 2.
    Arabi Y, Alshimemeri A, Taher S (2006) Weekend and weeknight admissions have the same outcome of weekday admissions to an intensive care unit with onsite intensivist coverage. Crit Care Med 34:605–611PubMedCrossRefGoogle Scholar
  3. 3.
    Hixson ED, Davis S, Morris S, Harrison M (2005) Do weekends or evenings matter in a pediatric intensive care unit? Pediatr Crit Care Med 6:523–530PubMedCrossRefGoogle Scholar
  4. 4.
    Kostis WJ, Demissie K, Marcella SW, Shao YH, Wilson AC, Moreyra AE (2007) Weekend versus weekday admission and mortality from myocardial infarction. New Engl J Med 356:1099–1109PubMedCrossRefGoogle Scholar
  5. 5.
    Stewart JH, Andrews J, Cartlidge PH (1998) Numbers of deaths related to intrapartum asphyxia and timing of birth in all Wales perinatal survey, 1993–5. BMJ 316:657–660PubMedGoogle Scholar
  6. 6.
    Heller G, Misselwitz B, Schmidt S (2000) Early neonatal mortality, asphyxia related deaths, and timing of low risk births in Hesse, Germany 1990–8: an observational study. BMJ 321:274–275PubMedCrossRefGoogle Scholar
  7. 7.
    Slater A, Shann F, Pearson G (2003) PIM2: a revised version of the Paediatric Index of Mortality. Intensive Care Med 29:278–285PubMedGoogle Scholar
  8. 8.
    Arias Y, Taylor DS, Marcin JP (2004) Association between evening admissions and higher mortality rates in the pediatric intensive care unit. Pediatrics 113:e530–534PubMedCrossRefGoogle Scholar
  9. 9.
    Ensminger SA, Morales IJ, Peters SG, Keegan MT, Finkielman JD, Lymp JF, Afessa B (2004) The hospital mortality of patients admitted to the ICU on weekends. Chest 126:1292–1298PubMedCrossRefGoogle Scholar
  10. 10.
    Wunsch H, Mapstone J, Brady T, Hanks R, Rowan K (2004) Hospital mortality associated with day and time of admission to intensive care units. Intensive Care Med 30:895–901PubMedCrossRefGoogle Scholar
  11. 11.
    Uusaro A, Kari A, Ruokonen E (2003) The effects of ICU admission and discharge times on mortality in Finland. Intensive Care Med 29:2144–2148PubMedCrossRefGoogle Scholar
  12. 12.
    Morales IJ, Peters SG, Afessa B (2003) Hospital mortality rate and length of stay in patients admitted at night to the intensive care unit. Crit Care Med 31:858–863PubMedCrossRefGoogle Scholar
  13. 13.
    Luyt CE, Combes A, Aegerter P, Guidet B, Trouillet JL, Gibert C, Chastre J (2007) Mortality among patients admitted to intensive care units during weekday shifts compared with “off” hours. Crit Care Med 35:3–11PubMedCrossRefGoogle Scholar
  14. 14.
    Nipshagen MD, Polderman KH, DeVictor D, Gemke RJ (2002) Pediatric intensive care: result of a European survey. Intensive Care Med 28:1797–1803PubMedCrossRefGoogle Scholar
  15. 15.
    Pollack MM, Cuerdon TC, Getson PR (1993) Pediatric intensive care units: results of a national survey. Crit Care Med 21:607–614PubMedCrossRefGoogle Scholar

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

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