title: Mortality associated with timing of admission to and discharge from ICU: a retrospective cohort study.
abstract: BACKGROUND
  Although the association between mortality and admission to intensive care units (ICU) in the "after hours" (weekends and nights) has been the topic of extensive investigation, the timing of discharge from ICU and outcome has been less well investigated. The objective of this study was to assess effect of timing of admission to and discharge from ICUs and subsequent risk for death.
  
  
  METHODS
  Adults (≥ 18 years) admitted to French ICUs participating in Outcomerea between January 2006 and November 2010 were included.
  
  
  RESULTS
  Among the 7,380 patients included, 61% (4,481) were male, the median age was 62 (IQR, 49-75) years, and the median SAPS II score was 40 (IQR, 28-56). Admissions to ICU occurred during weekends (Saturday and Sunday) in 1,708 (23%) cases, during the night (18:00-07:59) in 3,855 (52%), and on nights and/or weekends in 4,659 (63%) cases. Among 5,992 survivors to ICU discharge, 903 (15%) were discharged on weekends, 659 (11%) at night, and 1,434 (24%) on nights and/or weekends. After controlling for a number of co-variates using logistic regression analysis, admission during the after hours was not associated with an increased risk for death. However, patients discharged from ICU on nights were at higher adjusted risk (odds ratio, 1.54; 95% confidence interval, 1.12-2.11) for death.
  
  
  CONCLUSIONS
  In this study, ICU discharge at night but not admission was associated with a significant increased risk for death. Further studies are needed to examine whether minimizing night time discharges from ICU may improve outcome.
authors: University of Grenoble 1 (Joseph Fourier) Integrated Research Center U 823 - Albert Bonniot Institute, Rond Point de la Chantourne 38706, La Tronche Cedex, France.
authors: Kevin B
authors: KB
authors: Laupland
authors: Benoit
authors: B
authors: Misset
authors: Bertrand
authors: B
authors: Souweine
authors: Alexis
authors: A
authors: Tabah
authors: Elie
authors: E
authors: Azoulay
authors: Dany
authors: D
authors: Goldgran-Toledano
authors: Anne-Sylvie
authors: AS
authors: Dumenil
authors: Aurélien
authors: A
authors: Vésin
authors: Samir
authors: S
authors: Jamali
authors: Hatem
authors: H
authors: Kallel
authors: Christophe
authors: C
authors: Clec'h
authors: Michael
authors: M
authors: Darmon
authors: Carole
authors: C
authors: Schwebel
authors: Jean-Francois
authors: JF
authors: Timsit
mesh_terms: D000328:Adult; D039602:After-Hours Care; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D010343:Patient Admission; D010351:Patient Discharge; D018570:Risk Assessment; D013997:Time Factors