After-hours discharges from intensive care are associated with increased mortality
After-hours discharges from intensive care are associated with increased mortality
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DOI：
10.5694/j.1326-5377.2006.tb00266.x
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发表时间：
2006-04-03
影响因子：
11.4
通讯作者：
D Santamaria, John
中科院分区：
文献类型：
--
作者：
Tobin, Antony E.;D Santamaria, John
目的：调查患者从重症监护病房（ICU）转入医院病房的出院模式的变化，并确定出院时间对随后住院死亡率的影响。设计和参与者：对 1992 年 1 月至 2002 年 12 月 31 日期间从单个 ICU 活着出院的 10903 名患者进行回顾性队列研究。主要结局指标：院内死亡率。结果：在 10903 名从 ICU 活着出院的患者中，486 名(4.5%)在医院病房内死亡。当根据护理轮班对出院时间进行分类时（上午，07:00-14:59；下午，15:00-21:59；晚上，22:00-06:59），患者更有可能在下午班（比值比，3.63；95% Cl，3.05-4.30）或夜班（4.52；95% Cl， 3.15-6.64）2000-2002年与1992-1994年相比。在多重逻辑模型中，从 ICU 出院后的医院死亡率因 APACHE II 评分较高而增加（1.14；95% Cl，1.12-1.16）；从手术室 (1.47; 95% Cl, 1.11-1.95) 和从普通病房 (1.75; 95% Cl, 1.37-2.23) 进入 ICU，下午出院 (1.36; 95% Cl, 1.08-1.70) 和夜班 (1.63; 95% CI, 1.03-2.57).结论：在 11 年的时间里，越来越多的患者在下午和晚上从 ICU 出院，这表明 ICU 床位的压力越来越大。在这些轮班出院的患者死亡风险增加。
Objective: To investigate the change in pattern of discharge of patients from an intensive care unit (ICU) to hospital wards and to determine the impact of discharge time on subsequent hospital mortality.Design and participants: A retrospective cohort study of 10903 patients discharged alive from a single ICU between I January 1992 and 31 December 2002.Main outcome measure: In-hospital mortality.Results: Of the 10903 patients discharged alive from the ICU, 486 (4.5%) died in hospital wards. When discharge times were categorised according to nursing shift (morning, 07:00-14:59; afternoon, 15:00-21:59; and night, 22:00-06:59), patients were more likely to be discharged on an afternoon shift (odds ratio, 3.63; 95% Cl, 3.05-4.30) or night shift (4.52; 95% Cl, 3.15-6.64) in 2000-2002 compared with 1992-1994. In a multiple logistic model, hospital mortality after discharge from the ICU was increased by higher APACHE II score (1.14; 95% Cl, 1.12-1.16); admission to ICU from the operating room (1.47; 95% Cl, 1.11-1.95) and from the general ward (1.75; 95% Cl, 1.37-2.23), and discharge during the afternoon (1.36; 95% Cl, 1.08-1.70) and night shifts (1.63; 95% CI, 1.03-2.57).Conclusion: Over an 11-year period, more patients are being discharged from the ICU in the afternoon and night suggesting increasing pressure on ICU beds. Patients discharged on these shifts have an increased risk of death.