Off-Hours Admissions and Mortality in PICU Without 24-Hour Onsite Intensivist Coverage

Objective: To evaluate whether the off-hours admission has any effect on risk-adjusted mortality and length of stay for nonelective patients admitted to a pediatric intensive care unit (PICU) without 24-hour in-house intensivist coverage. Design: Prospective cohort study. Setting: A 34-bed tertiary...

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Bibliographic Details
Published in:	Journal of intensive care medicine Vol. 35; no. 7; pp. 698 - 703
Main Authors:	Thabet, Farah Chedly, alHaffaf, Faisal Ahmed, Bougmiza, Iheb Mohamed, Bafaqih, Hend Ali, Chehab, May Said, alMohaimeed, Sulaiman Abdulkareem
Format:	Journal Article
Language:	English
Published:	Los Angeles, CA SAGE Publications 01-07-2020
Subjects:	Adolescent After-Hours Care - statistics & numerical data Child Child, Preschool Critical Care Outcomes Female Hospital Mortality Humans Infant Infant, Newborn Intensive Care Units, Pediatric - statistics & numerical data Logistic Models Male Patient Admission - statistics & numerical data Prospective Studies Time Factors Workforce - statistics & numerical data after-hours care intensive care outcome pediatrics quality
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Summary:	Objective: To evaluate whether the off-hours admission has any effect on risk-adjusted mortality and length of stay for nonelective patients admitted to a pediatric intensive care unit (PICU) without 24-hour in-house intensivist coverage. Design: Prospective cohort study. Setting: A 34-bed tertiary PICU. Patients: All consecutive nonelective patients aged 0 to 14 years admitted from January 2012 to June 2015. Measurements and Main Results: A total of 1254 patients were nonelectively admitted to the PICU. They were categorized according to time of PICU admission as either office hours (07:30 to 16:30 from Sunday to Thursday and whenever an intensivist is present in the ICU) or off-hours (16:30 to 07:30, Friday and Saturday and public holidays). Standardized mortality rates (SMRs) of patients admitted during off-hours were compared to SMRs of patients admitted during office hours using Pediatric Risk of Mortality (PRISM2) score. Multivariate logistic regression was used to assess the effect of time of admission on outcome after adjustment for severity of illness using the PRISM2. The mortality observed in the office-hours group was 9.4% and in the off-hours group was 8.1%. The PRISM2-based SMR was 0.83 (95% confidence interval [CI]: 0.43-1.47) for the office-hours group and 0.68 (95% CI: 0.34-1.36) for the off-hours group. No significant differences in length of ICU stay or duration of mechanical ventilation were observed between patients admitted during off-hours and those admitted during office hours. In the logistic regression model, off-hours admission was not significantly associated with a higher mortality (odds ratio: 0.85, 95% CI: 0.57-1.27; P = .44). Conclusions: The absence of an in-house intensivist during off-hours is not associated with an increase in mortality, length of ICU stay, or duration of mechanical ventilation for patients admitted to our pediatric ICU.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0885-0666 1525-1489
DOI:	10.1177/0885066618778824