Thursday November 30, 2006
Let him stay overnight !!

Interesting study came out this month in Critical Care Medicine (Dec' 2006) on impact of ICU discharge time on patient outcome. It is an extensively large prospective study from 31 canadian community and teaching hospitals looking into 79,000 consecutive admissions.

Study found that: patients discharged (transferred to floor) from ICU at night had a 1.22-fold risk of dying in hospital compared with those discharged during the day. The mortality rate for those discharged during the day was 9.0% compared with 11.8% for those discharged at night. Night time is defined from 9 PM to 7 AM.

Multiple reasons from this and previous studies include:

• lower staff and nurse-to-patient ratios at night both in ICU as well as at floor.
• Demand for a bed for a new admission.
• Possible inadequate patient assessment/observation.
• Insufficient communication of transfer care plan.
• Possible relationship between DNR order and decrease care.
  

Related previous pearls:

Sign-out Mortality !
Monday-Friday 9-5 ICUs ! (weekend Mortality)



Reference: click to get abstract

Impact of intensive care unit discharge time on patient outcome - Critical Care Medicine. 34(12):2946-2951, December 2006