College of Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada.
Department of Critical Care, Saskatchewan Health Authority, Regina, Saskatchewan, Canada.
J Intensive Care Med. 2022 Feb;37(2):211-221. doi: 10.1177/0885066620984410. Epub 2020 Dec 28.
We evaluated the effects of after-hours/nighttime patient transfers out of the ICU on patient outcomes, by performing a systematic review and meta-analysis (PROSPERO CRD 42017074082).
MEDLINE, PubMed, EMBASE, Google Scholar, CINAHL, and the Cochrane Library from 1987-November 2019. Conference abstracts from the Society of Critical Care Medicine, American Thoracic Society, CHEST, Critical Care Canada Forum, and European Society of Intensive Care Medicine from 2011-2019.
Observational or randomized studies of adult ICU patients were selected if they compared after-hours transfer out of the ICU to daytime transfer on patient outcomes. Case reports, case series, letters, and reviews were excluded. Study year, country, design, co-variates for adjustment, definitions of after-hours, mortality rates, ICU readmission rates, and hospital length of stay (LOS) were extracted.
We identified 3,398 studies. Thirty-one observational studies (1,418,924 patients) were selected for the systematic review and meta-analysis. Included studies had varying definitions of after-hours, with the after-hours period starting anytime between 16:00-22:00 and ending between 06:00-09:00. Approximately 16% of transfers occurred after-hours. After-hours transfers were associated with increased in-hospital mortality for both unadjusted (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.30-1.75, = 96%, number of studies [n] = 26, < 0.001, low certainty) and adjusted (OR 1.32, 95% CI 1.25-1.38, = 33%, n = 10, < 0.001, low certainty) data, compared to daytime transfers. They were also associated with increased ICU readmission (pooled unadjusted OR 1.28, 95% CI 1.18-1.38, = 85%, n = 17, < 0.001, low certainty) and longer hospital LOS (standardized mean difference 0.13, 95% CI 0.09-0.18, = 93%, n = 9, < 0.001, low certainty), compared to daytime transfers.
After-hours transfers out of the ICU are associated with increased in-hospital mortality, ICU readmission, and hospital LOS, across many settings. While the certainty of evidence is low, future research is needed to reduce the number and effects of after-hours transfers.
通过系统评价和荟萃分析（PROSPERO CRD42017074082）评估 ICU 夜间/夜间患者转出对患者结局的影响。
1987 年至 2019 年 11 月期间的 MEDLINE、PubMed、EMBASE、Google Scholar、CINAHL 和 Cochrane 图书馆。2011 年至 2019 年期间，来自危重病医学会、美国胸科学会、胸科、加拿大危重病论坛和欧洲危重病医学会的会议摘要。
如果观察性或随机研究比较了 ICU 夜间患者转出与白天转出对患者结局的影响，则选择成年 ICU 患者。排除病例报告、病例系列、信件和综述。提取研究年份、国家、设计、调整协变量、夜间定义、死亡率、ICU 再入院率和住院时间（LOS）。
我们确定了 3398 项研究。31 项观察性研究（1418924 名患者）被纳入系统评价和荟萃分析。纳入的研究对夜间有不同的定义，夜间时段从 16:00 到 22:00 开始，到 06:00 到 09:00 结束。大约 16%的转移发生在夜间。夜间转移与住院死亡率增加相关，未经调整（比值比 [OR] 1.51，95%置信区间 [CI] 1.30-1.75， = 96%，研究数量 [n] = 26， < 0.001，低确定性）和调整（OR 1.32，95%CI 1.25-1.38， = 33%，n = 10， < 0.001，低确定性）数据相比，与白天转移相比。它们还与 ICU 再入院（合并未调整 OR 1.28，95%CI 1.18-1.38， = 85%，n = 17， < 0.001，低确定性）和更长的住院 LOS（标准化均数差 0.13，95%CI 0.09-0.18， = 93%，n = 9， < 0.001，低确定性）相关，与白天转移相比。
在许多情况下，ICU 夜间转出与住院死亡率增加、ICU 再入院和住院 LOS 延长有关。尽管证据确定性较低，但仍需要进一步研究以减少夜间转出的数量和影响。
