Association between ICU admission during morning rounds and mortality.
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.
Afessa
Bekele
B
Division of Pulmonary and Critical Care Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, MN. Electronic address: afessa.bekele@mayo.edu.
Gajic
Ognjen
O
Division of Pulmonary and Critical Care Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Morales
Ian J
IJ
Division of Pulmonary and Critical Care Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Keegan
Mark T
MT
Department of Internal Medicine, and the Division of Critical Care, Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Peters
Steve G
SG
Division of Pulmonary and Critical Care Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Hubmayr
Rolf D
RD
Division of Pulmonary and Critical Care Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, MN.
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006323:Heart Arrest / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009203:Myocardial Infarction / Q000628:therapy; D017063:Outcome Assessment, Health Care / Q000592:standards; D010343:Patient Admission / Q000706:statistics & numerical data*; D005791:Patient Care / Q000592:standards*; D012189:Retrospective Studies; D018805:Sepsis / Q000628:therapy; D012720:Severity of Illness Index; D020521:Stroke / Q000628:therapy; D056164:Teaching Rounds / Q000592:standards*; D013997:Time Factors