Clinical Investigations

Impact of intensive care unit discharge time on patient outcome

Priestap, Fran A. MSc; Martin, Claudio M. MD, FRCPC

From the Department of Medicine, London Health Sciences Centre, London, ON, Canada (FAP, CMM); The Critical Care Research Network, Centre for Critical Illness Research, Lawson Health Research Institute, London, ON, Canada (FAP, CMM); and the University of Western Ontario, Schulich School of Medicine & Dentistry, London, ON, Canada (CMM).

The authors have not disclosed any potential conflicts of interest.

Critical Care Medicine 34(12):p 2946-2951, December 2006. | DOI: 10.1097/01.CCM.0000247721.97008.6F

Abstract

Objective:

To determine the impact of nighttime intensive care unit (ICU) discharge on patient outcome.

Design:

Multiple-center, retrospective observational cohort study.

Setting:

Canadian hospitals.

Patients:

We used a prospectively collected dataset containing information on 79,090 consecutive admissions from 31 Canadian community and teaching hospitals.

Interventions:

None.

Measurements and Main Results:

Patients were categorized according to the time of ICU discharge into daytime (07:00–20:59) and nighttime (21:00–06:59). Admissions were excluded if the patients were a) ≤16 yrs of age (392); b) admitted following cardiac surgery (6,641); c) admitted following the initial admission for patients readmitted to the ICU within the same hospital stay (3,632); d) admitted due to a lack of available ward or specialty care beds (457); or c) transferred to another acute care facility (7,724). We found that 62,056 patients were discharged to the ward following the initial ICU admission. Of the 47,062 discharges eligible for analyses, 10.1% were discharged at night. The unadjusted odds of death for patients discharged from ICU at night was 1.35 (95% confidence interval, 1.23, 1.49), compared with patients discharged during the daytime. After adjustment for illness severity, source, case-mix, age, gender, and hospital size, the mortality risk was increased by 1.22-fold (95% confidence interval, 1.10, 1.36) for nighttime discharges. Multivariate regression analysis revealed that patients discharged from the ICU at night have a significantly shorter ICU length of stay than those discharged during the day (p < .001). Whereas hospital length of stay was similar for daytime and nighttime discharges who survived hospital stay, patients discharged at night who did not survive hospital stay had a significantly shorter hospital length of stay (p = .002).