Mortality Rate and Outcome among Patients Admitted to General Intensive Care Unit during “Morning-Hour” Compared with “Off-Hour”


Aim: This study aim to evaluate the effect of time of admission on mortality of patients admitted to the ICU. Method: This retrospective study included 391 of patients admitted to the ICU of an academic hospital during one year. Patients were categorized according to time of admission: working-hours and off-hours. Mortality was compared in the groups and associated factors of mortality were examined. Results: Two third of patients were admitted during off-hours. There was no significant difference in the GCS, age and length of stay among patients admitted during working-hours and off-hours. There was no difference in mortality among patients admitted during working-hours and off-hours Mortality was significantly higher in older and more severe cases, regardless of time of admission. Conclusion: Time of ICU admission does not have significant effect on patient’s outcome.

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S. Ala, N. Pakravan and M. Ahmadi, "Mortality Rate and Outcome among Patients Admitted to General Intensive Care Unit during “Morning-Hour” Compared with “Off-Hour”," International Journal of Clinical Medicine, Vol. 3 No. 3, 2012, pp. 171-177. doi: 10.4236/ijcm.2012.33035.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] J. L. Vincent, “Need for Intensivists in Intensive-Care Units,” Lancet, Vol. 356, No. 9231, 2000, pp. 695-696.
[2] P. J. Pronovost, D. C. Angus, T. Dorman, K. A. Robinson, T. T. Dremsizov and T. L. Young, “Physician Staffing Patterns and Clinical Outcomes in Critically Ill Patients: A Systematic Review,” Journal of American Medical Association, Vol. 288, No. 17, 2002, pp. 2151-2162. doi:10.1001/jama.288.17.2151
[3] C. E. Luyt, A. Combes, P. Aegerter, B. Guidet, J. L. Trouillet, C. Gibert, et al., “Mortality among Patients Admitted to Intensive Care Units During Weekday Day Shifts Compared with ‘Off’ Hours,” Critical Care Medicine, Vol. 35, No. 1, 2007, pp. 3-11. doi:10.1097/01.CCM.0000249832.36518.11
[4] E. Rivers, B. Nguyen, S. Havstad, J. Ressler, A. Muzzin, B. Knoblich, et al., “Early Goal-Directed Therapy in the Treatment of Severe Sepsis and Septic Shock,” New England Journal of Medicine, Vol. 345, No. 19, 2001, pp. 1368-1377. doi:10.1056/NEJMoa010307
[5] R. L. Kane, T. A. Shamliyan, C. Mueller, S. Duval and T. J. Wilt, “The Association of Registered Nurse Staffing Levels and Patient Outcomes: Systematic Review and Meta-Analysis,” Medical Care, Vol. 45, No. 12, 2007, pp. 1195-1204. doi:10.1097/MLR.0b013e3181468ca3
[6] Y. Arabi, A. Alshimemeri and S. Taher, “Weekend and Weeknight Admissions Have the Same Outcome of Weekday Admissions to an Intensive Care Unit with Onsite Intensivist Coverage,” Critical Care Medicine, Vol. 34, No. 3, 2006, pp. 605-611.
[7] M. J. Barnett, P. J. Kaboli, C. A. Sirio and G. E. Rosenthal, “Day of the Week of Intensive Care Admission and Patient Outcomes: A Multisite Regional Evaluation,” Medical Care, Vol. 40, No. 6, 2002, pp. 530-539. doi:10.1097/00005650-200206000-00010
[8] S. A. Ensminger, I. J. Morales, S. G. Peters, M. T. Keegan, J. D. Finkielman, J. F. Lymp, et al., “The Hospital Mortality of Patients Admitted to the ICU on Weekends,” Chest, Vol. 126, No. 4, 2004, pp. 1292-1298. doi:10.1378/chest.126.4.1292
[9] I. J. Morales, S. G. Peters and B. Afessa, “Hospital Mortality Rate and Length of Stay in Patients Admitted at Night to the Intensive Care Unit,” Critical Care Medicine, Vol. 31, Vol. 3, 2003, pp. 858-863.
[10] A. Numa, G. Williams, J. Awad and B. Duffy, “After-Hours Admissions Are Not Associated with Increased Risk-Adjusted Mortality in Pediatric Intensive Care,” Intensive Care Medicine, Vol. 34, No. 1, 2008, pp. 148-151.
[11] A. Uusaro, A. Kari and E. Ruokonen, “The Effects of ICU Admission and Discharge Times on Mortality in Finland,” Intensive Care Medicine, Vol. 29, No. 12, 2003, pp. 2144-2148. doi:10.1007/s00134-003-2035-1
[12] H. Wunsch, J. Mapstone, T. Brady, R. Hanks and K. Ro- wan, “Hospital Mortality Associated with Day and Time of Admission to Intensive Care Units,” Intensive Care Medicine, Vol. 30, No. 5, 2004, pp. 895-901. doi:10.1007/s00134-004-2170-3
[13] R. Cavallazzi, P. E. Marik, A. Hirani, M. Pachinburavan, T. S. Vasu and B. E. Leiby, “Association between Time of Admission to the ICU and Mortality: A Systematic Review and Meta Analysis,” Chest, Vol. 138, No. 1, 2010, pp. 68-75.
[14] K. B. Laupland, R. Shahpori, A. W. Kirkpa-trick and H. T. Stelfox, “Hospital Mortality among Adults Admitted to and Discharged from Intensive Care on Weekends and Evenings,” Journal of Critical Care, Vol. 23, No. 3, 2008, pp. 317-324. doi:10.1016/j.jcrc.2007.09.001
[15] Y. Numata, M. Schulzer, W. R. van der, J. Globerman, P. Semeniuk, E. Balka, et al., “Nurse Staffing Levels and Hospital Mortality in Critical Care Settings: Literature Review and Meta-Analysis,” Journal of Advanced Nursing, Vol. 55, No. 4, 2006, pp. 435-448. doi:10.1111/j.1365-2648.2006.03941.x
[16] C. M. Bell and D. A. Redelmeier, “Mortality among Patients Admitted to Hospitals on Weekends as Compared with Weekdays,” New England Journal of Medicine, Vol. 345, No. 9, 2001, pp. 663-668. doi:10.1056/NEJMsa003376
[17] P. Cram, S. L. Hillis, M. Barnett and G. E. Rosenthal, “Effects of Weekend Admission and Hospital Teaching Status on In-Hospital Mortality,” American Journal of Medicine, Vol. 117, No. 3, 2004, pp. 151-157. doi:10.1016/j.amjmed.2004.02.035
[18] J. B. Gould, C. Qin, A. R. Marks and G. Chavez, “Neonatal Mortality in Weekend vs Weekday Births,” Journal of American Medical Association, Vol. 289, No. 22, 2003, pp. 2958-2962. doi:10.1001/jama.289.22.2958
[19] M. C. Blunt and K. R. Burchett, “Out-of-Hours Consultant Cover and Case-Mix-Adjusted Mortality in Intensive Care,” Lancet, Vol. 356, No. 9231, 2000, pp. 735-736. doi:10.1016/S0140-6736(00)02634-9
[20] A. Y. Goh, L. C. Lum and M. E. bdel-Latif, “Impact of 24 Hour Critical Care Physician Staffing on Case-Mix Adjusted Mortality in Paediatric Intensive Care,” Lancet, Vol. 357, No. 9254, 2001, pp. 445-446. doi:10.1016/S0140-6736(00)04014-9
[21] M. M. Levy, J. Rapoport, S. Lemeshow, D. B. Chalfin, G. Phillips and M. Danis, “Association between Critical Care Physician Management and Patient Mortality in the Intensive Care Unit,” Annals of Internal Medicine, Vol. 148, No. 11, 2008, pp. 801-809.
[22] A. Combes, C. E. Luyt, J. L. Trouillet, J. Chastre and C. Gibert, “Adverse Effect on a Referral Intensive Care Unit’s Performance of Accepting Patients Transferred from Another Intensive Care Unit,” Critical Care Medicine, Vol. 33, No. 4, 2005, pp. 705-710. doi:10.1097/01.CCM.0000158518.32730.C5
[23] L. H. Aiken, S. P. Clarke and D. M. Sloane, “Hospital Staffing, Organization, and Quality of Care: Cross-National findings,” Nursing Outlook Journal, Vol. 50, No. 5 2002, pp. 187-194. doi:10.1067/mno.2002.126696
[24] R. K. Amaravadi, J. B. Dimick, P. J. Pronovost and P. A. Lipsett, “ICU Nurse-to-Patient Ratio Is Associated with Complications and Resource Use after Esophagectomy,” Intensive Care Medicine, Vol. 26, No. 12, 2006, pp. 1857-1862. doi:10.1007/s001340000720
[25] W. O. Tarnow-Mordi, C. Hau, A. Warden and A. J. Shearer, “Hospital Mortality in Relation to Staff Workload: A 4- Year Study in an Adult Intensive-Care Unit,” Lancet, Vol. 356, No. 9225, 2000, pp. 185-189. doi:10.1016/S0140-6736(00)02478-8
[26] P. G. Metnitz, A. Reiter, B. Jordan and T. Lang, “More Interventions Do Not Necessarily Improve Outcome in Critically Ill Patients,” Intensive Care Medicine. Vol. 30, No. 8, pp. 1586-1593.
[27] B. Afessa, O. Gajic, I. J. Morales, M. T. Keegan, S. G. Peters and R. D. Hubmayr, “Association between ICU Admission during Morning Rounds and Mortality,” Chest, Vol. 136, No. 6, 2009, pp. 1489-1495. doi:10.1378/chest.09-0529

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