Outcome of weekend and afterhour admissions compared with weekday and daytime admissions in the ICU with onsite intensivist coverage

Introduction

The objective of this study was to determine whether onsite intensivist coverage would improve the outcome of weekend and afterhour admissions in our ICU.

Methods

In a cohort study at a tertiary-care medical–surgical ICU staffed 24 hours/7 days by onsite consultant intensivists with predominantly North American Critical Care Board certifications, we included all ICU admissions (January 2007 to February 2008) from a prospectively collected ICU database. Results were stratified based on the time of the admission (daytime (8:00 to 17:00) or afterhour time (17:01 to 07:59)) and the day of the week (weekday or weekend). Predicted mortality rates were calculated using an APACHE IV prediction model. The primary outcome was hospital mortality, and standardized mortality ratios (SMRs) were calculated.

Results

A total of 1,315 admissions were included in the study. Forty-eight percent of patients were admitted in daytime and 52% in afterhour time with average APACHE IV scores of 59.8 and 55, respectively (P < 0.01), the SMR for the daytime group was 0.86 (95% CI = 0.69 to 1.05, P = 0.15) compared with an SMR of the afterhour group of 0.98 (95% CI = 0.84 to 1.15, P = 0.83). Seventy-two percent of patients were admitted on a weekday and 28% on weekends with average APACHE IV scores of 57.7 and 58.7, respectively (P = 0.52); there was no significant difference in mortality rates between the weekday and weekend groups (17.3% vs. 21.4, P = 0.09, with SMRs of 1.05 vs. 0.89). After adjustment for severity of illness it appears that there is a trend towards a lower mortality rate for daytime and weekday admissions compared with afterhour and weekend admissions; however, there is no statistical difference.

Conclusion

Our results indicate no difference in mortality rates for weekend and afterhour admissions to an ICU that is staffed by onsite certified intensivists.