Higher Mortality Seen in ICU Patients Admitted in the Morning

A new study has found that patients who are admitted to the intensive care unit (ICU) during morning rounds have more severe illness and higher mortality rates.

Researchers at the Mayo Clinic (Rochester, MN, USA) conducted a retrospective study that included 49,844 patients admitted from October 1994 to December 2007 to four ICUs--two surgical, one medical, and one multispecialty ICU. Of these patients, 3,580 were admitted to the ICU during round time (08:00-10:59) and 46,264 were admitted during non-round time (13:00-6:00). The researchers compared the baseline characteristics and outcome of patients admitted to the ICU between the two groups, which were similar in gender, ethnicity, and age, as was the hospital length of stay.

The results showed that ICU mortality was higher among round-time patients (10%) than among non-round-time patients (4.9%), as was hospital mortality (16.2% for round-time patients versus 8.8% for non-round-time patients). The researchers found that the risk of hospital death for round-time patients was 34% higher for medical, 24% higher for multispecialty, and 42% higher for surgical ICUs, compared with non-round-time patients. Overall ICU and in-hospital mortality rates of round-time versus non-round-time groups were 18.9% versus 14.5% for medical ICU admissions, 17.1% versus 10.3% for multispecialty ICU admissions, and 9.8% versus 4.4% for surgical ICU admissions. The study was published in the December 2009 issue of Chest.

"The golden hours of the critically ill require early diagnostic evaluation and intervention. The impact of such neglect is pronounced in the critically ill,” said lead author Bekele Afessa, M.D., of the division of pulmonary and critical care medicine. "Awareness and education, empowering the bedside nurses to call the physicians, and organizing the practice making some one available to manage the critically ill at all times may alleviate the problem.”

"Every ICU staff in academic teaching institutions must understand the importance of both patient care and medical education. The art of the educator is to find the balance, to engage the medical trainees in optimal patient care, and to include appropriate time for patient evaluation and care,” commented Amado Freire, M.D., and Jose Yataco, M.D., from the University of Tennessee Health Science Center (Memphis, USA), in an accompanying editorial. "Morning rounds can be adapted every morning to the acuteness of the conditions of the new patients who have been admitted....Rounding style in the ICU should be from 'the sickest patient to the least sick' rather than from one patient bed to the next.”

Related Links:
Mayo Clinic
University of Tennessee Health Science Center