Out of Hours Admission

Published Date: 19th July 2016

Publication Authors: , Harvey E, Downes C,

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INTRODUCTION.  Recent evidence suggests that patients admitted to hospitals in the UK over the weekend have an increased risk of death when compared to those admitted during the week[1]. Likewise, for intensive care admissions, studies suggest that mortality seems to be worse for patients admitted both out of hours[2] and at weekends[3], although data available from the UK is limited.

OBJECTIVES.  To assess whether outcomes for patients admitted to intensive care are different depending on time and day of admission. To determine if mortality is worse for patients that are brought to intensive care after hours and at the weekend in a UK setting.

METHODS.  This was a retrospective cohort study of all patients that were admitted to a UK general and burns intensive care unit (ICU) from December 2010 to December 2011. Burns patients were excluded from the final analysis. Outcomes were compared for 3 groups of patients; those admitted during the daytime, out of hours and at weekends. Outcome measures included ICU length of stay, ventilator days, ICU and in-hospital mortality.

RESULTS.  There were 694 admissions during the study period, 24 burns patients were excluded. 51% of patients were male and the mean age was 59. 27% of patients were admitted out of hours (Monday to Friday 20:00 to 07:59) and 30% were admitted at the weekend (Friday 20:00 to Monday 07:59). There was no significant difference between the 3 groups with respect to age, sex, mean APACHEII score and proportion of ventilated patients.Median length of stay for patients admitted during daytime hours was 3 days, compared to 2 days and 3 days for out of hours and weekend admissions respectively. Patients admitted during the day were ventilated for a median of 3 days compared with 2 days for out of hours and 3 days for weekend admissions. ICU mortality for daytime admissions was 16% compared to 11% for weekend (p=0.08) and 16.7% out of hours. In-hospital mortality rates were 22% for daytime admissions, 21.5% for weekend and 22.8% for those admitted out of hours. Subgroup analysis did not reveal a significant difference in outcomes when comparing medical and surgical patients.

CONCLUSIONS.  Admission to the ICU out of hours and at weekends did not lead to increased length of stay or number of days ventilated. ICU and in-hospital mortality rates were not statistically different for patients admitted out of hours or at weekends compared to the daytime.

Lowsby, R; Harvey, E; Downes, C and Sim, K. (2012).  Out of hours admission to intensive care: Does it make a difference? . Intensive Care Medicine. 38 (Supplement 1), S179-180 

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