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Off-hours admission and mortality in two pediatric intensive care units without 24-h in-house senior staff attendanceOpen access

Babette Peeters| Nicolaas J. G. Jansen| Casper W. Bollen| Adrianus J. van Vught| Douwe van der Heide| Marcel J. I. J. Albers
Pediatric Original
Volume 36, Issue 11 / November , 2010

Pages 1923 - 1927

Abstract

Purpose

To compare risk-adjusted mortality of children non-electively admitted during off-hours with risk-adjusted mortality of children admitted during office hours to two pediatric intensive care units (PICUs) without 24-h in-house attendance of senior staff.

Design

Prospective observational study, performed between January 2003 and December 2007, in two PICUs without 24-h in-house attendance of senior staff, located in tertiary referral children’s hospitals in the Netherlands.

Methods

Standardized mortality rates (SMRs) of patients admitted during off-hours were compared to SMRs of patients admitted during office hours using Pediatric Index of Mortality (PIM1) and Pediatric Risk of Mortality (PRISM2) scores. Office hours were defined as week days between 8:00 a.m. and 6:00 p.m., with in-house attendance of senior staff, and off-hours as week days between 6:00 p.m. and 8:00 a.m., Saturdays, Sundays and public holidays, with one resident covering the PICU and senior staff directly available on-call.

Results

Of 3,212 non-elective patients admitted to the PICUs, 2,122 (66%) were admitted during off-hours. SMRs calculated according to PIM1 and PRISM2 did not show a significant difference with those of patients admitted during office hours. There was no significant effect of admission time on mortality in multivariate logistic regression with odds ratios of death in off-hours of 0.95 (PIM1, 95% CI 0.71–1.27, = 0.73) and 1.03 (PRISM2, 95% CI 0.76–1.39, p = 0.82).

Conclusion

Off-hours admission to our PICUs without 24-h in-house attendance of senior staff was not associated with higher SMRs than admission during office hours when senior staff were available in-house.

Keywords

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