ICU admission during round time is associated with increased mortality

Introduction

In one of our ICUs, we started a two-intensivist coverage system during the day, with each intensivist admitting new patients every other day. The purpose of this study was to test the hypothesis that the increased mortality associated with round-time ICU admissions will disappear with the two-intensivist coverage system.

Methods

This retrospective study involves analyses of data from the APACHE III database of three ICUs (medical, surgical, and mixed). The study period was from January 2001 through December 2006. A daytime two-intensivist coverage was introduced in the medical ICU in April 2002. Daily morning patient rounds were usually performed from 8:00 to 11:00 a.m. Data collected included the Acute Physiology Score, APACHE III score, predicted mortality, and hospital mortality. Comparisons were made between round-time and nonround-time ICU admissions. The odds ratio and 95% confidence intervals were calculated. P < 0.05 is considered statistically significant.

Results

There were 25,209 ICU admissions during the study period (41.3% medical ICU, 31.6% mixed ICU, and 27.2% surgical ICU). Of the 25,206 admissions, 2,160 (8.6%) were admitted during morning rounds. Differences between round-time and nonround-time admissions are presented in Table 1. A logistic regression analysis showed that both predicted probability of death (OR, 95% CI = 187, 159–220) and round-time admission (OR, 95% CI = 1.589, 1.386–1.821) were independently associated with increased mortality. Round-time admission was an independent risk factor for mortality in each of the three ICUs. For the medical ICU, the implementation of two-intensivist coverage did not improve the independent association of round-time admission with increased mortality (OR, 95% CI = 1.611, 1.326–1.957).

Table 1 Differences between round-time admissions and nonround-time admissions

Conclusion

ICU admission during round time is independently associated with increased mortality. Appropriate allocation of staffing during round time may improve patient outcome.