The effect of intensive care unit out-of-hours admission on mortality
A systematic review and meta-analysis
A systematic review and meta-analysis
File(s)
Accepted version
Accepted version
Author(s)
Type
Journal Article
Abstract
Objectives: Organizational factors are associated with outcome of
critically ill patients and may vary by time of day and day of week.
We aimed to identify the association between out-of-hours admission
to critical care and mortality.
Data Sources: MEDLINE (via Ovid) and EMBASE (via Ovid).
Study Selection: We performed a systematic search of the literature
for studies on out-of-hours adult general ICU admission on
patient mortality.
Data Extraction: Meta-analyses were performed and Forest plots
drawn using RevMan software. Data are presented as odds ratios
([95% CIs], p values).
Data Synthesis: A total of 16 studies with 902,551 patients were
included in the analysis with a crude mortality of 18.2%. Fourteen
studies with 717,331 patients reported mortality rates by
time of admission and 11 studies with 835,032 patients by day
of admission. Admission to ICU at night was not associated with
an increased odds of mortality compared with admissions during
the day (odds ratio, 1.04 [0.98–1.11]; p = 0.18). However, admissions
during the weekend were associated with an increased odds
of death compared with ICU admissions during weekdays (1.05
[1.01–1.09]; p = 0.006). Increased mortality associated with
weekend ICU admissions compared with weekday ICU admissions
was limited to North American countries (1.08 [1.03–1.12];
p = 0.0004). The absence of a routine overnight on-site intensivist
was associated with increased mortality among weekend
ICU admissions compared with weekday ICU admissions (1.11
[1.00–1.22]; p = 0.04) and nighttime admissions compared with
daytime ICU admissions (1.11 [1.00–1.23]; p = 0.05).
Conclusions: Adjusted risk of death for ICU admission was greater
over the weekends compared with weekdays. The absence of a
dedicated intensivist on-site overnight may be associated with
increased mortality for acute admissions. These results need to
be interpreted in context of the organization of local healthcare
resources before changes to healthcare policy are implemented.
critically ill patients and may vary by time of day and day of week.
We aimed to identify the association between out-of-hours admission
to critical care and mortality.
Data Sources: MEDLINE (via Ovid) and EMBASE (via Ovid).
Study Selection: We performed a systematic search of the literature
for studies on out-of-hours adult general ICU admission on
patient mortality.
Data Extraction: Meta-analyses were performed and Forest plots
drawn using RevMan software. Data are presented as odds ratios
([95% CIs], p values).
Data Synthesis: A total of 16 studies with 902,551 patients were
included in the analysis with a crude mortality of 18.2%. Fourteen
studies with 717,331 patients reported mortality rates by
time of admission and 11 studies with 835,032 patients by day
of admission. Admission to ICU at night was not associated with
an increased odds of mortality compared with admissions during
the day (odds ratio, 1.04 [0.98–1.11]; p = 0.18). However, admissions
during the weekend were associated with an increased odds
of death compared with ICU admissions during weekdays (1.05
[1.01–1.09]; p = 0.006). Increased mortality associated with
weekend ICU admissions compared with weekday ICU admissions
was limited to North American countries (1.08 [1.03–1.12];
p = 0.0004). The absence of a routine overnight on-site intensivist
was associated with increased mortality among weekend
ICU admissions compared with weekday ICU admissions (1.11
[1.00–1.22]; p = 0.04) and nighttime admissions compared with
daytime ICU admissions (1.11 [1.00–1.23]; p = 0.05).
Conclusions: Adjusted risk of death for ICU admission was greater
over the weekends compared with weekdays. The absence of a
dedicated intensivist on-site overnight may be associated with
increased mortality for acute admissions. These results need to
be interpreted in context of the organization of local healthcare
resources before changes to healthcare policy are implemented.
Date Issued
2018-01-02
Date Acceptance
2017-10-03
Citation
Critical Care Medicine, 2018, 46 (2), pp.290-299
ISSN
0090-3493
Publisher
Lippincott, Williams & Wilkins
Start Page
290
End Page
299
Journal / Book Title
Critical Care Medicine
Volume
46
Issue
2
Subjects
1103 Clinical Sciences
1110 Nursing
1117 Public Health And Health Services
Emergency & Critical Care Medicine
Publication Status
Published