An examination of cardiovascular intensive care unit mortality based on admission day and time

• Published in: Heart & lung Vol. 50; no. 5; pp. 579 - 586
• Main Authors: Langston, Matthew C., Subedi, Keshab, Fabrizio, Carly, Wimmer, Neil J., Choudhry, Usman I., Urrutia, Luis E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2021
• Subjects: Adult; APACHE III; Cardiovascular ICU; Hospital Mortality; Hospitalization; Humans; Intensive Care Units; Mortality; Retrospective Studies; Time Factors; Weekend admission; APACHE III; Cardiovascular ICU; Mortality; Weekend admission
• ISSN: 0147-9563; 1527-3288
• DOI: 10.1016/j.hrtlng.2021.02.011

•CICU patients are more likely to die if admitted on a weekend versus a weekday.•Increasing patient complexity was also associated with higher ICU mortality.•Weekend day admissions versus other admission times had an increased length of stay. Recent interest in the ‘weekend effect’ has been expanded to cardiovascular intensive care units, yet the impact of off-hours admission on mortality and cardiovascular ICU (CICU) length of stay remains uncertain. We examine the association between CICU admission day and time with mortality. Additionally, length-of-stay was also evaluated in relation to admission time. A single-center, retrospective cohort study was conducted including 10,638 adult patients admitted to a CICU in a tertiary-care academic medical center from July 1, 2012 to June 30, 2019. ICU mortality and length-of-stay were assessed by admission day and time adjusting for comorbid conditions and other clinical variables. We used logistic regression models to evaluate the factors associated with mortality and a generalized linear model (GLM) with log link function and gamma distribution was used to evaluate the factors associated with ICU length of stay. Compared to weekday-day admissions, we observed an increased mortality for weekend-day for all admissions (6.5 vs 9.6%, Adjusted OR: 1.32 (1.03–1.72)), and for medical CICU admissions (7.6 vs 9.9%, Adjusted OR: 1.35 (1.02–1.79)). Additionally, compared to weekday-day, weekday-night admission was associated with 7% longer ICU length of stay in surgical ICU patients, 7% shorter length of stay in medical ICU patients. Admission to this open-model CICU during weekend hours (Saturday 08:00-Sunday 17:59) versus nights or weekdays is associated with increased mortality. ICU staffing care models should not significantly change based on the day of the week.