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BMC Health Services Research

, 11:321

Quality, performance, safety and outcomes

Abstract

BackgroundAlthough the association between mortality and admission to intensive care units ICU in the -after hours- weekends and nights has been the topic of extensive investigation, the timing of discharge from ICU and outcome has been less well investigated. The objective of this study was to assess effect of timing of admission to and discharge from ICUs and subsequent risk for death.

MethodsAdults ≥18 years admitted to French ICUs participating in Outcomerea between January 2006 and November 2010 were included.

ResultsAmong the 7,380 patients included, 61% 4,481 were male, the median age was 62 IQR, 49-75 years, and the median SAPS II score was 40 IQR, 28-56. Admissions to ICU occurred during weekends Saturday and Sunday in 1,708 23% cases, during the night 18:00-07:59 in 3,855 52%, and on nights and-or weekends in 4,659 63% cases. Among 5,992 survivors to ICU discharge, 903 15% were discharged on weekends, 659 11% at night, and 1,434 24% on nights and-or weekends. After controlling for a number of co-variates using logistic regression analysis, admission during the after hours was not associated with an increased risk for death. However, patients discharged from ICU on nights were at higher adjusted risk odds ratio, 1.54; 95% confidence interval, 1.12-2.11 for death.

ConclusionsIn this study, ICU discharge at night but not admission was associated with a significant increased risk for death. Further studies are needed to examine whether minimizing night time discharges from ICU may improve outcome.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-11-321 contains supplementary material, which is available to authorized users.

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Autor: Kevin B Laupland - Benoit Misset - Bertrand Souweine - Alexis Tabah - Elie Azoulay - Dany Goldgran-Toledano - Anne-Sylvie 

Fuente: https://link.springer.com/







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