title: Does admission during morning rounds increase the mortality of patients in the medical ICU?
abstract: BACKGROUND
  Early optimization of treatment is crucial when admitting patients to the ICU and could depend on the organization of the medical team. The aim of this retrospective observational study was to determine whether admissions during morning rounds are independently associated with hospital mortality in a medical ICU.
  
  
  METHODS
  The 3,540 patients admitted from May 2000 to April 2010 to the medical ICU of Sainte Marguerite Hospital in Marseille, France, were divided into two groups based on the time of admission.The non-morning rounds group was admitted between 1:00 PM and 7:59 AM , and the morningrounds group was admitted between 8:00 AM and 12:59 PM . Hospital mortality (crude and adjusted)was compared between the two groups.
  
  
  RESULTS
  The 583 patients (16.5%) admitted during morning rounds were older and sicker upon admission compared with those patients admitted during non-morning rounds. The crude hospital mortality was 35.2% (95% CI , 31.4-39.1) in the group of patients admitted during morning rounds and 28.0% (95% CI, 26.4-29.7) in the other group ( P < .001). An admission during morning rounds was not independently associated with hospital death (adjusted hazard ratio, 1.10; 95% CI,0.94-1.28; P 5=.24).
  
  
  CONCLUSIONS
  Being admitted to the medical ICU during morning rounds is not associated with a poorer outcome than afternoon and night admissions. The conditions of the patients admitted during morning rounds were more severe, which underlines the importance of the ICU team’s availability during this time. Further studies are needed to evaluate if the presence of a specific medical team overnight in the wards would be able to improve patients’ outcome by preventing delayed ICU admission.
authors.affiliation: Aix-Marseille Université, UMR D2, Marseille, France; Assistance Publique Hopitaux de Marseille, Hôpital la Timone, Réanimation des Urgences et Médicale, Marseille, France. Electronic address: magali.bisbal@ap-hm.fr.
authors.forename: Magali
authors.initials: M
authors.lastname: Bisbal
authors.affiliation: Aix-Marseille Université, Laboratoire de Santé Publique EA3279, Marseille, France; Assistance Publique Hopitaux de Marseille, Hôpitaux Sud, Service de Santé Publique et d'Information Médicale, Marseille, France.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Pauly
authors.affiliation: Aix-Marseille Université, UMR D2, Marseille, France; Assistance Publique Hopitaux de Marseille, Hôpital la Timone, Réanimation des Urgences et Médicale, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Gainnier
authors.affiliation: Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes CNRS-UMR 6236, Marseille, France; Assistance Publique Hopitaux de Marseille, Hôpital Nord, Réanimation, Marseille, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Forel
authors.affiliation: Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes CNRS-UMR 6236, Marseille, France; Assistance Publique Hopitaux de Marseille, Hôpital Nord, Réanimation, Marseille, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Roch
authors.affiliation: Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes CNRS-UMR 6236, Marseille, France; Assistance Publique Hopitaux de Marseille, Hôpital Nord, Réanimation, Marseille, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Guervilly
authors.affiliation: Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes CNRS-UMR 6236, Marseille, France; Assistance Publique Hopitaux de Marseille, Hôpital Nord, Réanimation, Marseille, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Demory
authors.affiliation: Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes CNRS-UMR 6236, Marseille, France; Assistance Publique Hopitaux de Marseille, Hôpital Nord, Réanimation, Marseille, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Arnal
authors.affiliation: Assistance Publique Hopitaux de Marseille, Hôpital Nord, Réanimation, Marseille, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Michel
authors.affiliation: Aix-Marseille Université, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes CNRS-UMR 6236, Marseille, France; Assistance Publique Hopitaux de Marseille, Hôpital Nord, Réanimation, Marseille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Papazian
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013995:Time