Intensive Care Unit, The Canberra Hospital, Canberra, ACT.
Crit Care Resusc. 2010 Sep;12(3):156-61.
To assess the frequency of after-hours discharges of patients from the intensive care unit and its effect on in-hospital mortality.
DESIGN, SETTING AND PARTICIPANTS: Observational cohort study conducted in the ICU of Westmead Hospital, a tertiary care teaching hospital in Sydney. All adult patients admitted to the ICU between 1 January 2004 and 31 December 2006 were included in the study cohort. Patients were grouped into two categories based on the time of discharge from the ICU: during work hours (08:00-17:59 hours) or after-hours (18:00-07:59 hours).
Mortality after discharge from the ICU according to time of discharge.
2300 patients accounted for 2451 admission episodes during the study period. There were 151 readmissions, involving 133 patients (5.8%). Excluded from the study cohort were 36 patients (1.6%) who were discharged home, 39 (1.7%) who were transferred to other hospitals, and 354 (15.4%) who died during their first stay in the ICU. Data on the remaining 1871 patients who were discharged alive at the end of their first ICU admission were included in our analysis. Of these patients, 1221 (65.3%) were discharged from the ICU during work-hours and 650 (34.7%) after-hours. Crude mortality for patients discharged after-hours was 13.7%, compared with 10.1% for those discharged during work hours. After adjustment for age, APACHE II score and discharge destination, the risk of mortality among patients discharged after-hours was statistically significant (adjusted odds ratio, 1.38 [95% CI, 1.01-1.88]; P < 0.05).
A high proportion of patients (34.7%) were discharged from the ICU after-hours. Discharge after-hours was associated with a higher risk of in-hospital mortality than discharge during work hours.
评估重症监护病房（ICU）患者下班后出院的频率及其对院内死亡率的影响。
设计、地点和参与者：这是一项在悉尼西摩德医院 ICU 进行的观察性队列研究。所有 2004 年 1 月 1 日至 2006 年 12 月 31 日期间入住 ICU 的成年患者均被纳入研究队列。根据 ICU 出院时间将患者分为两组：工作时间（08:00-17:59 小时）或下班后（18:00-07:59 小时）。
根据出院时间评估 ICU 出院后的死亡率。
在研究期间，2300 名患者共涉及 2451 次入院。有 151 例再入院，涉及 133 名患者（5.8%）。排除研究队列的患者包括 36 名（1.6%）出院回家的患者、39 名（1.7%）转院的患者和 354 名（15.4%）在 ICU 首次住院期间死亡的患者。在 ICU 首次入住期间存活出院的其余 1871 名患者的数据被纳入我们的分析。其中，1221 名（65.3%）患者在工作时间从 ICU 出院，650 名（34.7%）患者在下班后出院。下班后出院患者的死亡率为 13.7%，而工作时间出院患者的死亡率为 10.1%。调整年龄、急性生理和慢性健康评分（APACHE II）和出院目的地后，下班后出院患者的死亡风险具有统计学意义（调整优势比，1.38[95%置信区间，1.01-1.88]；P<0.05）。
下班后从 ICU 出院的患者比例较高（34.7%）。下班后出院与院内死亡率升高相关，高于工作时间出院。
