Laupland Kevin B, Shahpori Reza, Kirkpatrick Andrew W, Stelfox H Thomas
Department of Critical Care Medicine, University of Calgary and Calgary Health Region, Calgary, Alberta, Canada.
J Crit Care. 2008 Sep;23(3):317-24. doi: 10.1016/j.jcrc.2007.09.001.
Patient care may be inconsistent during off hours. We sought to determine whether adults admitted to or discharged from intensive care units (ICUs) on evenings and weekends have increased mortality rates.
All adults admitted to ICUs in the Calgary Health Region, Alberta, Canada, during 2000 to 2006 were included. The in-hospital mortality risk was assessed with admissions or discharges on weekdays (Monday to Friday) and daytime (8:00 am to 5:59 pm) as compared with weekends (Saturday and Sunday) and nights (6:00 pm to 7:59 am).
Intensive care unit admissions (n = 20466) occurred during weekends in 18%, nights in 41%, and nights and/or weekends in 49%. Among the 17864 survivors to ICU discharge, 26% were discharged on weekends, 21% at night, and 41% on nights and/or weekends. Increased crude mortality rates were associated with both admission (24% vs 14%, P < .0001) and discharge (12% vs 5%, P < .0001) during nights as compared with days. Admission to (26% vs 16%, P < .0001) but not discharge from (6% vs 7%, P = .42) ICU during weekends as compared with weekdays was associated with increased mortality. After controlling for confounding variables using logistic regression analyses, neither weekend admission nor discharge was associated with death. However, both night admission and discharge were independently associated with mortality.
Our observations of excess risk associated with admission to or discharge from ICU at night merits further exploration as to whether it may reflect inconsistencies in care after hours.
非工作时间的患者护理可能存在不一致的情况。我们试图确定在夜间和周末入住重症监护病房（ICU）或从ICU出院的成年人死亡率是否会升高。
纳入2000年至2006年期间在加拿大艾伯塔省卡尔加里健康区域入住ICU的所有成年人。将工作日（周一至周五）和白天（上午8:00至下午5:59）的入院或出院情况与周末（周六和周日）及夜间（下午6:00至上午7:59）的情况进行比较，评估住院期间的死亡风险。
ICU入院（n = 20466）情况为，18%发生在周末，41%发生在夜间，49%发生在夜间和/或周末。在17864名从ICU出院的幸存者中，26%在周末出院，21%在夜间出院，41%在夜间和/或周末出院。与白天相比，夜间入院（24%对14%，P <.0001）和出院（12%对5%，P <.0001）的粗死亡率均升高。与工作日相比，周末入住ICU（26%对16%，P <.0001）但出院时（6%对7%，P =.42）与死亡率升高相关。使用逻辑回归分析控制混杂变量后，周末入院和出院均与死亡无关。然而，夜间入院和出院均独立与死亡率相关。
我们观察到夜间入住或出院ICU存在额外风险，这是否可能反映非工作时间护理的不一致性，值得进一步探究。
