ABSTRACT
Introducción: La estructura organizacional de las Unidades de Cuidados Intensivos está basada en turnos, con cambios en los equipos durante la noche y los fines de semana-festivos (FdS-F). Se ha descrito una mayor mortalidad en los ingresos realizados durante estos períodos. Nuestro objetivo es evaluar si la mortalidad de los pacientes ingresados a nuestra unidad se ve influenciada porel horario nocturno o los FdS-F. Metodología: Estudio retrospectivo de la cohorte de pacientes ingresados desde el 1 de enero al 31 de diciembre de 2011 en el Hospital Clínico Regional Valdivia. Se consideró turno día (TD)el comprendido entre las 08:00 AM y las 20:59 PM, y el turno noche (TN) entre las 21:00 y las 07:59 horas. Se asignó como horario de fin de semana al comprendido entre el día viernes a las21:00 horas y el lunes a las 07:59. Dentro de esta misma categoría se incluyeron los festivos, con el mismo rango horario descrito. Base de datos en Excel MAC y análisis estadístico con Vassar Stats. Resultados: Durante el año 2011, se produjeron 425 ingresos, con una mortalidad global de 25 por ciento, variando según el tipo de patología que motivó el ingreso a la unidad (sepsis 45 por ciento, cardiovascular 17 por ciento, respiratorio 30 por ciento, neurológico 26 por ciento, trauma 24 por ciento, digestivo 32 por ciento, renal 14 por ciento, otras 18 por ciento). Los principales motivos de ingreso fueron las patologías cardiovasculares (32 por ciento), sepsis (18 por ciento) y enfermedades respiratorias (14 por ciento). El 51 por ciento requirió de Ventilación Mecánica Invasiva. El tiempo de estadía fue una mediana de 3 días (0-80). El 48 por ciento de los pacientes ingresó en el horario de TD, 38 por ciento en TN, sin contar con la hora de ingreso en el 14 por ciento de los casos. La mortalidad de los pacientes ingresados en TN fue 30 por ciento y los ingresados en TD 25 por ciento (OR 1,29 IC 95 por ciento 0,8126-2,0393; p= 0,29)...
Introduction: The job in most of Intensive Care Units (ICU) is organized in shift work, this system includes the activities performed during nights and weekends or holidays (W-HD). Higher mortality has been described in patients admitted at nights and W-HD. We decided to study if mortality in our unit was related to the admission during these periods. Methods: We reviewed the clinical records of patients admitted at the ICU of Valdivia Hospital since January 31, 2011 to December 31, 2011. Day shift (DS) was defined between 8:00 and 20:59 hours, night shift (NS) between 21:00 and 7:59 hours, weekend was considered as the period between Friday at 21:00hours and Monday at 7:59 and finally, holiday was considered as the period between the previous date at 21:00 and next day at 7:59 hours of a non-laboral day. Data were analyzed with Microsoft EXCEL for Mac and Vassar stats software. Results: four hundred twenty five patients were admitted at the ICU during this period, the mortality was 25 percent. It was different according with type of disease (sepsis 45 percent, cardiovascular disease 17 percent, respiratory disease 30 percent, neurologic disease 26 percent, trauma 24 percent, gastrointestinal disease 32 percent, renal disease 14 percent, others 18 percent). The most frequent causes of admission were cardiovascular diseases (32 percent), sepsis (19 percent) and respiratory diseases (14 percent). 51 percent of patients were submitted to mechanical ventilation. The median of staying in the unit was 3 days (0-80 days). 48 percent of patients were entered at the unit at DS, 38 percent at NS and in 14 percent of cases the time of admission was not registered. Mortality of patients admitted was 30 percent in NS and 25 percent in DS (OR 1,29 CI 95 percent 0,8126-2,0393; p=0,29)...
Subject(s)
Humans , Patient Admission/statistics & numerical data , Hospital Mortality , Intensive Care Units/statistics & numerical data , Cause of Death , Chile , Retrospective Studies , Time FactorsABSTRACT
BACKGROUND AND PURPOSE: Stroke requires consistent care, but there is concern over the "weekend effect", whereby a weekend admission results in a poor outcome. Our aim was to determine the impact of weekend admission on clinical outcomes in patients with acute ischemic stroke in Korea. METHODS: The outcomes of patients admitted on weekdays and weekends were compared by analyzing data from a prospective outcome registry enrolling 1247 consecutive patients with acute ischemic stroke admitted to four neurology training hospitals in South Korea between September 2004 and August 2005. The primary outcome was a poor functional outcome at 3 months, defined as modified Rankin Scale (mRS) of 3-6. Secondary outcomes were 3-month mortality, use of thrombolysis, complication rate, and length of hospitalization. Shift analysis was also performed to compare overall mRS distributions. RESULTS: On weekends, 334 (26.8%) patients were admitted. Baseline characteristics were comparable between the weekday and weekend groups except for more history of heart disease and shorter admission time in weekend group. Univariate analysis revealed poor functional outcome at 3 months, 3-month mortality, complication rate, and length of hospitalization did not differ between the two groups. In addition, overall mRS distributions were comparable (p=0.865). After adjusting for baseline factors and stroke severity, weekend admission was not associated with poor functional outcome at 3 months (adjusted odds ratio, 1.05; 95% CI, 0.74-1.50). Furthermore, none of secondary endpoints differed between the two groups in multivariate analysis. CONCLUSIONS: Weekend admission was not associated with poor functional outcome than weekday admission in patients with acute ischemic stroke in this study. The putative weekend effect should be explored further by considering a wider range of hospital settings and hemorrhagic stroke.