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Mortality related to after-hours discharge from intensive care in Australia and New Zealand, 2005–2012

Dashiell Gantner| KJ Farley| Michael Bailey| Sue Huckson| Peter Hicks| David Pilcher
Original
Volume 40, Issue 10 / October , 2014

Pages 1528 - 1535

Abstract

Introduction

After-hours discharge from the intensive care unit (ICU) is associated with adverse patient outcomes including increased ICU readmissions and mortality. Since Australian and New Zealand data were last published, overall ICU patient mortality has decreased; however it is unknown whether changes in discharge practices have contributed to these improved outcomes. Our aim was to examine trends over time in discharge timing and the contemporary associations with mortality and ICU readmission.

Methods

Retrospective cohort study using data from the Australian and New Zealand Intensive Care Society Adult Patient Database (ANZICS APD) for patients admitted to Australian and New Zealand ICUs between January 2005 and December 2012. Data collected included patient characteristics, time of ICU discharge, hospital mortality and ICU readmissions.

Results

Between 1 January 2005 and 31 December 2012, there were 710,535 patients available for analysis, of whom 109,384 (15.4 %) were discharged after-hours (1800–0600 hours). There were no changes in timing of ICU discharge over the 8 years of the study. Patients discharged after-hours had a higher hospital mortality (6.4 versus 3.6 %; P < 0.001) and more ICU readmissions (5.1 versus 4.5 %; P < 0.001) than patients discharged in-hours. Although post-ICU mortality for all patients declined during the study period, the risk associated with after-hours discharge remained elevated throughout (odds ratio 1.34, 95 % confidence intervals 1.30–1.38).

Conclusions

After-hours discharge remains an important independent predictor of hospital mortality and readmission to ICU. Despite widespread dissemination this evidence has not translated into fewer after-hours discharges or reduction in risk in Australian and New Zealand hospitals.

Keywords

References

  1. Pilcher DV, Duke GJ, George C et al (2007) After-hours discharge from intensive care increases the risk of readmission and death. Anaesth Intensive Care 35:477–485
    • View reference on PubMed
  2. Harrison DA, Gao H, Welch CA, Rowan KM (2010) The effects of critical care outreach services before and after critical care: a matched-cohort analysis. J Crit Care 25:196–204. doi:10.1016/j.jcrc.2009.12.015
    • View reference on PubMed
    • View reference on publisher's website
  3. Tobin AE, Santamaria JD (2006) After-hours discharges from intensive care are associated with increased mortality. Med J Aust 184:334–337
    • View reference on PubMed
  4. Goldfrad C, Rowan K (2000) Consequences of discharges from intensive care at night. Lancet 355:1138–1142. doi:10.1016/S0140-6736(00)02062-6
    • View reference on PubMed
    • View reference on publisher's website
  5. Beck D, McQuillan P, Smith G (2002) Waiting for the break of dawn? Intensive Care Med 28:1287–1293. doi:10.1007/s00134-002-1412-5
  6. Duke GJ, Green JV, Briedis JH (2004) Night-shift discharge from intensive care unit increases the mortality-risk of ICU survivors. Anaesth Intensive Care 32:697–701
    • View reference on PubMed
  7. Laupland KB, Shahpori R, Kirkpatrick AW, Stelfox HT (2008) Hospital mortality among adults admitted to and discharged from intensive care on weekends and evenings. J Crit Care 23:317–324. doi:10.1016/j.jcrc.2007.09.001
    • View reference on PubMed
    • View reference on publisher's website
  8. Australian Council on Healthcare Standards (2011) Intensive care indicators: clinical indicator user manual 2012. AHCS, Sydney, Australia, pp 1–68
  9. Zimmerman JE, Kramer AA, Knaus WA (2013) Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012. Crit Care 17:R81. doi:10.1186/cc12695
    • View reference on PubMed
    • View reference on publisher's website
  10. Kaukonen M, Bailey M, Suzuki S et al (2014) Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000–2012. JAMA 311(13):1308–1316. doi:10.1001/jama.2014.2637
    • View reference on PubMed
    • View reference on publisher's website
  11. ANZICS CORE (2013) Centre for outcome and resource evaluation annual report 2011–2012. Australian and New Zealand Intensive Care Society, Melbourne
  12. Hosein FS, Bobrovitz N, Berthelot S et al (2013) A systematic review of tools for predicting severe adverse events following patient discharge from intensive care units. Crit Care 17:R102. doi:10.1186/cc12747
    • View reference on PubMed
    • View reference on publisher's website
  13. Jones DA, DeVita MA, Bellomo R (2011) Rapid-response teams. N Engl J Med 365:139–146. doi:10.1056/NEJMra0910926
    • View reference on PubMed
    • View reference on publisher's website
  14. O’Leary R, Strange J, McKimm A et al (2013) ICU should improve the night-time hospital. JICS 14:284–287
  15. Stow PJ, Hart GK, Higlett T et al (2006) Development and implementation of a high-quality clinical database: the Australian and New Zealand Intensive Care Society Adult Patient Database. J Crit Care 21:133–141. doi:10.1016/j.jcrc.2005.11.010
    • View reference on PubMed
    • View reference on publisher's website
  16. Knaus WA, Wagner DP, Draper EA et al (1991) The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100:1619–1636
    • View reference on PubMed
    • View reference on publisher's website
  17. Morris PE (2009) Assessing ICU transfers at night: a call to reduce mortality and readmission risk. Am J Crit Care 18:6–8. doi:10.4037/ajcc2009944
    • View reference on PubMed
    • View reference on publisher's website
  18. Hillman K, Chen J, Cretikos M et al (2005) Introduction of the medical emergency team (MET) system: a cluster-randomised controlled trial. Lancet 365:2091–2097. doi:10.1016/S0140-6736(05)66733-5
    • View reference on PubMed
    • View reference on publisher's website
  19. Azoulay E, Adrie C, De Lassence A et al (2003) Determinants of postintensive care unit mortality: a prospective multicenter study. Crit Care Med 31:428–432. doi:10.1097/01.CCM.0000048622.01013.88
    • View reference on PubMed
    • View reference on publisher's website
  20. Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (2013) Intensive care resources and activity in Australia and New Zealand—Activity Report 2010-11, ANZICS. ACHS, Melbourne, Australia, pp 1–55
  21. Australian Council on Healthcare Standards (2013) Australasian clinical indicator report: 2005–2012. ACHS, Sydney, Australia, pp 1–128
  22. Mokart D, Lambert J, Schnell D et al (2013) Delayed intensive care unit admission is associated with increased mortality in patients with cancer with acute respiratory failure. Leuk Lymphoma 54:1724–1729. doi:10.3109/10428194.2012.753446
    • View reference on PubMed
    • View reference on publisher's website
  23. Bing-Hua YU (2014) Delayed admission to intensive care unit for critically surgical patients is associated with increased mortality. Am J Surg. doi:10.1016/j.amjsurg.2013.08.044
    • View reference on PubMed
  24. Badawi O, Breslow MJ (2012) Readmissions and death after ICU discharge: development and validation of two predictive models. PLoS One 7:e48758. doi:10.1371/journal.pone.0048758
    • View reference on PubMed
    • View reference on publisher's website

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