Mortality related to after-hours discharge from intensive care in Australia and New Zealand, 2005–2012
- 15 August 2014
- journal article
- Published by Springer Science and Business Media LLC in Intensive Care Medicine
- Vol. 40 (10), 1528-1535
- https://doi.org/10.1007/s00134-014-3438-x
Abstract
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. 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. 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 P 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
This publication has 20 references indexed in Scilit:
- A systematic review of tools for predicting severe adverse events following patient discharge from intensive care unitsCritical Care, 2013
- Readmissions and Death after ICU Discharge: Development and Validation of Two Predictive ModelsPLOS ONE, 2012
- Rapid-Response TeamsNew England Journal of Medicine, 2011
- The effects of critical care outreach services before and after critical care: A matched-cohort analysisJournal of Critical Care, 2010
- Assessing ICU Transfers at Night: A Call to Reduce Mortality and Readmission RiskAmerican Journal of Critical Care, 2009
- Hospital mortality among adults admitted to and discharged from intensive care on weekends and eveningsJournal of Critical Care, 2008
- Development and implementation of a high-quality clinical database: the Australian and New Zealand Intensive Care Society Adult Patient DatabaseJournal of Critical Care, 2006
- Determinants of postintensive care unit mortality: A prospective multicenter studyCritical Care Medicine, 2003
- Waiting for the break of dawn?Intensive Care Medicine, 2002
- The APACHE III Prognostic SystemChest, 1991