By: Joann Schulte, DO, MPH
|Photo by Philip Dean via Flickr|
New research published this month in Pediatrics (doi: 10.1542/peds.2014-1071) found off-hour admissions were associated with a decreased risk of mortality, but morning admissions were associated with an increased likelihood of death. The study was based on a retrospective cohort, assembled using information from a database containing data from 234,192 admissions to 99 hospitals between January 2009 and September 2012. The study ICUs represent about 30 percent of the pediatric ICUs in the United States. The team at Wake Forest University in North Carolina, headed by Dr. Michael McCrory, used a primary outcome of ICU death and defined off-hour admissions as any occurring after 7 p.m. and weekends as Saturday and Sunday.
Other factors associated with an increased risk of mortality included neonatal and infant ages, trauma admission and transfer admissions from inpatient locations or other ICUs. The authors said additional work is needed to evaluate why the morning time period was associated with the peak morality in this study.
This study is important because it adds information about factors associated with leaving the pediatric ICU to go home. So what should this article tell you as a general pediatrician or as a sub-specialist who might have a patient admitted to the ICU? And if you’re practicing in an ICU, what should you tell the referring physician or patient’s parents?
If you’re the referring physician, perhaps you ought to ask about the 24/7 coverage of the ICU and how it is staffed. Does your patient admitted to the ICU have specific issues or parameters or labs that are especially important to monitor no matter what time of day it is? If you’re the ICU physician, has your unit done any monitoring to know temporal patterns of mortality among patients?
This Pediatrics article presents evidence that physicians, no matter what their practice area, need to understand more about the content of care their patients receive day or night in an inpatient setting—in this study, one that focuses on critical care.