de Souza IA, Karvellas CJ, Gibney RN, Bagshaw SM.; Crit Care. 2012 May 3;16(3):R72. [Epub ahead of print]
INTRODUCTION: Recent data has suggested that patient admission during intensive care unit (ICU) morning bedside rounds is associated with less favorable outcome. We undertook the present study to explore the association between morning round-time ICU admissions and hospital mortality in a large Canadian health region.
METHODS: Multi-center retrospective cohort study performed at five hospitals in Edmonton, Canada, between July, 2002 and December, 2009. Round-time ICU admission was defined occurring between 8:00am to 11:59am. Multivariable logistic regression analysis was used to explore the association between round-time admission and outcome.
RESULTS: Of 18,857 unique ICU admissions, 2,055 (10.9%) occurred during round-time. Round-time admissions were more frequent in community hospitals compared with tertiary hospitals (12.0% vs. 10.5%; odds ratio [OR] 1.16; 95% CI, 1.05-1.29, P<0.004) and from the ward compared with the emergency department (ED) or operating theatre (17.5% vs. 9.2%; OR 2.1; 95% CI, 1.9-2.3, P<0.0001). Round-time admissions were more often medical than surgical (12.6% vs. 6.6%; OR 2.06; 95% CI, 1.83-2.31, P<0.0001), had more comorbid illness (11.9% vs. 10.5%; OR 1.15; 95% CI, 1.04-1.27, P<0.008), higher APACHE II score (22.2 vs. 21.3, P<0.001), and more likely to have a primary diagnosis of respiratory failure (37.0% vs. 31.3%, P<0.001) or sepsis (11.1% vs. 9.0%, P=0.002). Crude ICU (15.3% vs. 11.6%; OR 1.38; 95% CI, 1.21-1.57, P<0.0001) and hospital (23.9% vs. 20.6%; OR 1.21; 95% CI, 1.09-1.35, P<0.001) mortality were higher for round-time compared with non-round-time admissions. In multi-variable analysis, round-time admission was associated with increased ICU mortality (OR 1.19, 95% CI, 1.03-1.38, P=0.017); however, not significantly associated with hospital mortality (OR 1.02; 95% CI, 0.90-1.16, P=0.700). In the subgroup admitted from the ED, round-time admission showed significantly higher ICU mortality (OR 1.54; 95% CI, 1.21-1.95; P<0.001) and a trend for higher hospital mortality (OR 1.22; 95% CI, 0.99-1.51, P=0.057).
CONCLUSIONS: Approximately 1 in 10 patients are admitted during morning rounds. These patients are more commonly admitted from the ward and are burdened by comorbidities, are non-operative, and have higher illness severity. These patients admitted during morning rounds have higher observed ICU mortality; however, no difference in hospital mortality.
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