Orsini Jose, Rajayer Salil, Ahmad Noeen, Din Nanda, Morante Joaquin, Malik Ryan, Shim Ahmed
Department of Medicine, New York University School of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, NY, USA;
Department of Medicine, New York University School of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, NY, USA.
J Community Hosp Intern Med Perspect. 2016 Dec 15;6(6):33478. doi: 10.3402/jchimp.v6.33478. eCollection 2016.
Studies have shown that patients admitted to hospitals on weekends and after-hours experience worse outcome than those admitted on weekdays and daytime hours. Although admissions of patients to intensive care units (ICUs) occur 24 hours a day, not all critical care units maintain the same level of staffing during nighttime, weekends, and holidays. This raises concerns in view of evidence showing that the organizational structure of an ICU influences the outcome of critically ill patients. The objective of this study is to evaluate the effects of day and time of admission to ICU on patients' outcome.
A single-center, prospective, observational study was conducted among all consecutive admissions to ICU in a community teaching hospital during a 4-month period.
A total of 282 patients were admitted during the study period. Their mean age was 59.5 years (median 59, range 17-96), and the majority were male (157, 55.7%). Mean Acute Physiology and Chronic Health Evaluation (APACHE)-II score was 18.9 (median 33, range 1-45), and mean ICU length of stay was 3.1 days (median 2, range 1-19). Of the patients, 104 patients (36.9%) were admitted during weekends and 178 (63.1%) during weekdays. A total of 122 patients (43.3%) were admitted after-hours, constituting 68.5% of all admissions during weekdays. Fifty-six patients (19.9%) were admitted during daytime hours, representing 31.5% of all weekday admissions. Forty-five patients (15.9%) died in ICU. Compared to patients admitted on weekends, those admitted on weekdays had increased ICU mortality (operating room (OR)=0.437; 95% confidence interval=0.2054-0.9196; 0.0293).
Admissions to ICU during weekends were not independently associated with increased mortality. A linear relationship between weekdays and after-hours admissions to ICU with mortality was observed at our institution.
研究表明，在周末和非工作时间入院的患者比在工作日和白天入院的患者预后更差。尽管重症监护病房（ICU）每天24小时都有患者入院，但并非所有重症监护病房在夜间、周末和节假日都保持相同的人员配备水平。鉴于有证据表明ICU的组织结构会影响重症患者的预后，这引发了人们的担忧。本研究的目的是评估入住ICU的日期和时间对患者预后的影响。
在一家社区教学医院进行了一项为期4个月的单中心、前瞻性观察性研究，纳入所有连续入住ICU的患者。
研究期间共收治282例患者。他们的平均年龄为59.5岁（中位数59岁，范围17 - 96岁），大多数为男性（157例，55.7%）。急性生理与慢性健康状况评分系统（APACHE）-II平均评分为18.9分（中位数33分，范围1 - 45分），ICU平均住院时间为3.1天（中位数2天，范围1 - 19天）。其中，104例患者（36.9%）在周末入院，178例（63.1%）在工作日入院。共有122例患者（43.3%）在非工作时间入院，占工作日所有入院患者的68.5%。56例患者（19.9%）在白天入院，占工作日所有入院患者的31.5%。45例患者（15.9%）在ICU死亡。与周末入院的患者相比，工作日入院的患者ICU死亡率更高（比值比（OR）=0.437；95%置信区间=0.2054 - 0.9196；P = 0.0293）。
周末入住ICU与死亡率增加无独立相关性。在我们机构观察到工作日和非工作时间入住ICU与死亡率之间存在线性关系。
