Document Detail


Association between ICU admission during morning rounds and mortality.
MedLine Citation:
PMID:  19505985     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: No previous study has evaluated the association between admission to ICUs during round time and patient outcome. The objective of this study was to determine the association between round-time ICU admission and patient outcome.
METHODS: This retrospective study included 49,844 patients admitted from October 1994 to December 2007 to four ICUs (two surgical, one medical, and one multispecialty) of an academic medical center. Of these patients, 3,580 were admitted to the ICU during round time (8:00 am to 10:59 am) and 46,264 were admitted during nonround time (from 1:00 pm to 6:00 am). The medical ICU had 24-h/7-day per week intensivist coverage during the last 2 years of the study. We compared the baseline characteristics and outcome of patients admitted to the ICU between the two groups. Data were abstracted from the acute physiology and chronic health evaluation (APACHE) III database.
RESULTS: The round-time and non-round-groups were similar in gender, ethnicity, and age. The predicted hospital mortality rate of the round time group was higher (17.4% vs 12.3% predicted, respectively; p < 0.001). The hospital length of stay was similar between the two groups. The round-time group had a higher hospital mortality rate (16.2% vs 8.8%, respectively; p < 0.001). Most of the round-time ICU admissions and deaths occurred in the medical ICU. Round-time admission was an independent risk factor for hospital death (odds ratio, 1.321; 95% CI, 1.178 to 1.481). This independent association was present for the whole study period except for the last 2 years.
CONCLUSIONS: Patients admitted to the ICU during morning rounds have higher severity of illness and mortality rates.
Authors:
Bekele Afessa; Ognjen Gajic; Ian J Morales; Mark T Keegan; Steve G Peters; Rolf D Hubmayr
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2009-06-08
Journal Detail:
Title:  Chest     Volume:  136     ISSN:  1931-3543     ISO Abbreviation:  Chest     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-09     Completed Date:  2009-12-31     Revised Date:  2011-07-22    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1489-95     Citation Subset:  AIM; IM    
Affiliation:
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA. afessa.bekele@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
APACHE
Adult
Aged
Aged, 80 and over
Female
Heart Arrest / therapy
Hospital Mortality / trends*
Humans
Intensive Care Units / statistics & numerical data*
Logistic Models
Male
Middle Aged
Minnesota
Myocardial Infarction / therapy
Outcome Assessment (Health Care) / standards
Patient Admission / statistics & numerical data*
Patient Care / standards*
Retrospective Studies
Sepsis / therapy
Severity of Illness Index
Stroke / therapy
Teaching Rounds / standards*
Time Factors
Grant Support
ID/Acronym/Agency:
1 UL1 RR024150/RR/NCRR NIH HHS
Comments/Corrections
Comment In:
Chest. 2009 Dec;136(6):1449-51   [PMID:  19995759 ]
Chest. 2010 May;137(5):1253-4; author reply 1254   [PMID:  20442135 ]
Chest. 2010 Jun;137(6):1488; author reply 1488-9   [PMID:  20525668 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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