Chest
Volume 136, Issue 6, December 2009, Pages 1489-1495
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Original Research
Critical Care Medicine
Association Between ICU Admission During Morning Rounds and Mortality

https://doi.org/10.1378/chest.09-0529Get rights and content

Background

No previous study has evaluated the association between admission to ICUs during round time and patient outcome. The objective of this study was to determine the association between round-time ICU admission and patient outcome.

Methods

This retrospective study included 49,844 patients admitted from October 1994 to December 2007 to four ICUs (two surgical, one medical, and one multispecialty) of an academic medical center. Of these patients, 3,580 were admitted to the ICU during round time (8:00 am to 10:59 am) and 46,264 were admitted during nonround time (from 1:00 pm to 6:00 am). The medical ICU had 24-h/7-day per week intensivist coverage during the last 2 years of the study. We compared the baseline characteristics and outcome of patients admitted to the ICU between the two groups. Data were abstracted from the acute physiology and chronic health evaluation (APACHE) III database.

Results

The round-time and non-round-groups were similar in gender, ethnicity, and age. The predicted hospital mortality rate of the round time group was higher (17.4% vs 12.3% predicted, respectively; p < 0.001). The hospital length of stay was similar between the two groups. The round-time group had a higher hospital mortality rate (16.2% vs 8.8%, respectively; p < 0.001). Most of the round-time ICU admissions and deaths occurred in the medical ICU. Round-time admission was an independent risk factor for hospital death (odds ratio, 1.321; 95% CI, 1.178 to 1.481). This independent association was present for the whole study period except for the last 2 years.

Conclusions

Patients admitted to the ICU during morning rounds have higher severity of illness and mortality rates.

Section snippets

Materials and Methods

To monitor patient outcome and quality of care, four adult ICUs at our institution have used the acute physiology and chronic health evaluation (APACHE) III prognostic system since October 1994.16 This retrospective study involves the analysis of APACHE III data that were prospectively collected at the Mayo Medical Center (Rochester, MN) from October 1994 through December 2007. The study was approved by the Institutional Review Board. The Mayo Medical Center is a tertiary teaching institution

Results

Excluding 2,291 admissions for lack of research authorization, 5,992 admissions for admission to the intermediate care area, 5,944 admissions because they were repeat admissions, and 6,244 admissions because they were patients admitted to the ICU between 6:00 am and 7:59 am or 11:00 am and 12:59 pm, 49,844 of 70,315 admissions in the APACHE III database were included in the study. Of the study patients, 3,580 (7.2%) were admitted during round time. Patients in the round-time group were more

Discussion

In this study, we found ICU admission during morning rounds was associated with an increased severity-adjusted mortality rate in both postoperative and non-postoperative admissions. Patients admitted to the ICU during round time had higher severity of illness, and were more likely to be non-postoperative patients and transfers from regular wards in the same hospital. The medical ICU accounted for the highest number of deaths and round-time admissions. The association between round-time

Acknowledgments

Author contributions: Dr. Afessa contributed to the conception and design of the study, and acquisition as well as analysis and interpretation of data; drafted the submitted article and revised it; and approved the final submitted version. Dr. Gajic contributed to the conception and design of the study, and acquisition as well as analysis and interpretation of data; participated in revising the article; and approved the final submitted version. Dr. Morales contributed to the conception and

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Funding/Support: This project was supported by the Office of Faculty Development, Department of Medicine, Mayo Clinic (Rochester, MN) and by grant 1 UL1 RR024150 from the National Center for Research Resources, which is a component of the National Institutes of Health, and the National Institutes of Health Roadmap for Medical Research.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

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