Consequences of discharges from intensive care at night
Consequences of discharges from intensive care at night
复制标题
DOI：
10.1016/s0140-6736(00)02062-6
复制
发表时间：
2000-04-01
期刊：
影响因子：
168.9
通讯作者：
Rowan, K
中科院分区：
文献类型：
--
作者：
Goldfrad, C;Rowan, K
背景人们普遍认为，在英国，重症监护病房(ICU)的床位压力已经增加。方法以夜间出院时间为指标，以2200~0659 h和0000~0459h两种方式定义夜间出院时间，比较1995~98年间62个ICU入院21 295人和1988~90年间26个ICU入院10 806人的夜间出院情况。只利用1995-98年的数据，调查了夜间出院和提前出院的后果。结果显示，1988-90年间有2269人(21.0%)未能在ICU中存活，而1995-98年间有4487人(21.1%)。在ICU幸存者中，1988-90年间有2.7%的患者在夜间(2200-0659小时)出院，而1995-98年间这一比例为6.0%。1995~1998年夜间出院(2200~0659 h)患者的粗死亡率(优势比1.46，95%可信区间1.18~1.80)和病例组合调整后的最终住院死亡率(1.33，1.06~1.65)较高。当夜间的定义为0000-0459h时，优势比较高。早泄在夜间较为常见，42.6%对5.0%，当纳入Logistic回归模型时，其重要性变得明显(早泄1.35，1.10-1.65；夜间放电1.17，0.92-1.49)。这种做法令人担忧，因为夜间出院的患者比白天出院的患者情况要差得多。在相关临床医生看来，夜间排泄更有可能是“过早”的。这些结果表明，许多医院的重症监护床位不足。然而，在决定是否在深切治疗部投入更多资源时，我们必须考虑这项服务与其他可使用额外资源的方法相比的成本效益。
Background It is generally believed that pressure for beds on intensive-care units (ICUs) has increased in the UK. This study used discharge at night as a proxy measure to investigate pressure.Methods Night was defined in two ways: "out of office hours' from 2200 to 0659 h and "the early hours of the morning" from 0000 to 0459 h. The rate of discharge at night was compared for 21 295 adult admissions to 62 ICUs covering the period 1995-98 with 10 806 admissions to 26 ICUs covering the period 1988-90. With data solely from 1995-98, the consequences of discharge at night and premature discharge were investigated.Findings Overall, 2269 (21.0%) admissions did not survive the ICU in 1988-90 compared with 4487 (21.1%) in 1995-98. Of ICU survivors, 2.7% were discharged at night (2200-0659 h) in 1988-90 compared with 6.0% in 1995-98. In 1995-98, night discharges (2200-0659 h) had a higher crude (odds ratio 1.46, 95% CI 1.18-1.80) and case-mix adjusted (1.33, 1.06-1.65) ultimate hospital mortality. Higher odds ratios were observed when the definition of night was 0000-0459 h. Premature discharge was commoner at night, 42.6% vs 5.0% and its importance was apparent when incorporated into the logistic-regression model (premature discharge 1.35, 1.10-1.65; night discharge 1.17, 0.92-1.49).Interpretation Night discharges from ICU are increasing in the UK. This practice is of concern because patients discharged at night fare significantly worse than those discharged during the day. Night discharges are more likely to be "premature" in the view of the clinicians involved. The implication of these results is that many hospitals have insufficient intensive-care beds. In deciding whether or not to invest more resources in intensive care we must, however, consider the cost-utility of this particular service compared with other ways that additional resources could be used.