Publications

Abstract

How to cite this article: Krishna B. Day and Time of Admission to ICU Affects Patient Outcome: An Illogical Belief? Indian J Crit Care Med 2024;28(5):414–415.

Keywords: Intensive care units mortality, Manpower, Time of admission

Intensive care units (ICUs) are specialized service units where critically ill patients get admitted any time of the day or week. The critical condition of these patients warrants immediate delivery of medical and or surgical services to ensure favorable patient outcomes. The healthcare delivery may vary during a 24-hour and 7-day week period due to lack of availability of services.

Hospital organizational structure across the globe is such that the weekdays and office hours are well equipped for optimal healthcare delivery and the nights and weekends (off hours) are affected by lean ICU staffing and the non-availability of some hospital services.1 The imbalance in delivery of services with respect to the day and time of ICU admission leading to delays in diagnosis, resuscitation, treatment, or postponements in investigations or procedures on critically ill patients, adversely affecting their ICU and hospital outcome. This phenomenon has been aptly termed as the “night effect” and “weekend effect” depending on the hour or day of the week.2–4 This effect although evident in smaller hospitals, unfortunately, exists even in tertiary care referral hospitals.

Contrary to this belief, the evidence has so far been controversial with respect to the association between the day and time of ICU admission and outcome.

Several studies have demonstrated the association between increased ICU and hospital mortality when patients were admitted to the ICU during the off hours.5–8 An explanation for increased mortality in patients admitted during off hours was increased severity of illness leading to untimely admission to the ICU. The association of increased mortality for patients admitted during off hours was noted in these studies even after correction for severity of illness.

An equal number of studies have shown no association between time of admission and ICU outcome.9–11 This could be explained by the possibility of organizational structure and functioning of these ICUs, or the definitions used for office and off hours, differences in casemix or severity of illness, and sample size.

It is interesting to note that some studies have shown better outcomes for patients admitted during off hours to the ICU.12 Several explanations have been proposed for this observation. Nurses and doctors have more administrative, documentation, academic, or training responsibilities during office hours, hampering dedicated and sufficient time for patient care. An increase in a number of procedures during office hours leads to more activities and disturbances in the continuity of patient care.