Abstract
OBJECTIVE:Several reports have indicated increased mortality for weekend and nighttime admissions to the intensive care unit. This increase has been attributed to differences in staffing levels. The impact of onsite 24-hr/7-day intensivist staffing on weekend and weeknight outcomes has not been examined before. The objective of this study was to determine whether weekend and nighttime admissions compromise patient outcome in an intensive care unit staffed by an onsite intensivist 24 hrs a day and 7 days a week.
DESIGN:Cohort study.
SETTING:Tertiary care medical-surgical intensive care unit staffed 24 hrs/7 days by onsite consultant intensivists with predominantly North American Critical Care Board certifications.
PATIENTS:We included all emergency admissions over 4 yrs (March 1999 to February 2003) from a prospectively collected intensive care unit database. Admissions were grouped into weekday, weeknight, and weekend admissions.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:Predicted mortality rates were calculated using Mortality Probability Models II0 and II24. The primary outcome was hospital mortality. Standardized mortality ratios were calculated. Secondary end points included intensive care unit mortality, duration of mechanical ventilation, intensive care unit length of stay, and the need for renal replacement therapy, tracheostomy, and pulmonary artery catheter during the intensive care unit course. A total of 2,093 admissions were included in the study, of which 31% were admitted on weekdays, 35% on weeknights, and 34% on weekends. The three groups were similar in baseline characteristics. There was no significant difference in hospital mortality rates among the three time periods (36%, 36%, and 37%, respectively, p = .90). There were also no significant differences in any of the secondary end points.
CONCLUSIONS:In an intensive care unit staffed by onsite certified intensivists 24 hrs/7 days, we found no compromise in the care of patients admitted during weekends and weeknights. These findings suggest that such coverage helps in ensuring consistency of care and therefore represents a potentially improved model for intensive care unit practice.