title: Effect of the timing of admission upon patient prognosis in the Intensive Care Unit: On-hours versus off-hours.
abstract: OBJECTIVE
  To assess the repercussion of the timing of admission to the ICU upon patient prognosis.
  
  
  METHODS
  A prospective, observational, non-interventional cohort study was carried out.
  
  
  METHODS
  A second level hospital with 210 operational beds and a general ICU with 8 operational beds.
  
  
  METHODS
  The study comprised all patients admitted to the ICU during 3 years (January 2010 to December 2012), excluding those subjects admitted from the operating room after scheduled surgery. The patients were divided into 2 groups according to the timing of admission (on-hours or off-hours).
  
  
  METHODS
  Non-interventional study.
  
  
  METHODS
  An analysis was made of demographic variables (age, sex), origin (emergency room, hospital ward, operating room), comorbidities and SAPS 3 as severity score upon admission, length of stay in the ICU and hospital ward, and ICU and hospital mortality.
  
  
  RESULTS
  A total of 504 patients were included in the on-hours group, versus 602 in the off-hours group. Multivariate analysis showed the factors independently associated to hospital mortality to be SAPS 3 (OR 1.10; 95% CI 1.08-1.12), and off-hours admission (OR 2.00; 95% CI 1.20-3.33). In a subgroup analysis of the off-hours group, the admission of patients on weekends or non-working days compared to daily night shifts was found to be independently associated to hospital mortality (OR 2.30; 95% CI 1.23-4.30).
  
  
  CONCLUSIONS
  Admission to the ICU in off-hours is independently associated to patient mortality, which is also higher in patients admitted on weekends and non-working days compared to the daily night shifts.
authors: Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España.
authors: A
authors: A
authors: Abella
authors: Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España.
authors: C
authors: C
authors: Hermosa
authors: Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España.
authors: V
authors: V
authors: Enciso
authors: Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España.
authors: I
authors: I
authors: Torrejón
authors: Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España.
authors: R
authors: R
authors: Molina
authors: Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España.
authors: M
authors: M
authors: Díaz
authors: Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España.
authors: T
authors: T
authors: Mozo
authors: Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España. Electronic address: fgordo5@gmail.com.
authors: F
authors: F
authors: Gordo
authors: Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, España.
authors: I
authors: I
authors: Salinas
mesh_terms: D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D010343:Patient Admission; D010561:Personnel Staffing and Scheduling; D011379:Prognosis; D011446:Prospective Studies; D013997:Time Factors
keywords: Critical care; Cuidados críticos; Decision support techniques; Diagnóstico precoz; Early diagnosis; Equipos de respuesta rápida; Herramientas de decisión clínica; Hospital rapid response team; Momento de ingreso; Outcome; Pronóstico; Time admission