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Correspondence |

Morning Rounds Becoming Mourning Rounds? FREE TO VIEW

Jack J. Ligtenberg, MD; L. Marion Dijkema, MD; Jan G. Zijlstra, MD
Author and Funding Information

From the University Medical Center Groningen, Department of Critical Care.

Correspondence to: Jack J. Ligtenberg, MD, University Medical Center Groningen, Department of Critical Care (ICV), PO Box 30.001, Groningen, The Netherlands, NL-9700RB; e-mail: j.j.m.ligtenberg@icv.umcg.nl


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(5):1253-1254. doi:10.1378/chest.09-2952
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To the Editor:

In their elaborate study, Afessa et al (December 2009)1 suggest a relationship between ICU mortality and admission during morning rounds (8:00 am-11:00 am). A relatively small number of the patients (7.2%) were admitted during round time. However, these patients differed from the average ICU admission: They had a higher severity of illness, were less likely to be postoperative, and were more frequently admitted to the medical ICU.

Based on standardized mortality ratio (SMR), which is used to compare observed mortality with predicted mortality, the authors conclude that mortality rate during morning rounds is higher than predicted mortality rate. They pose the question whether patient care during round times falls short. We also work at a mixed ICU with 24/7 coverage of inhouse intensivists/fellows and have rounds from 11:00 am to 1:00 pm. We recognize this type of patient admitted early in the morning, but we do not think that they get insufficient care once admitted at the ICU. These are usually patients already staying at the (internal) ward and deteriorating during the night. We do not think the SMR is developed to predict mortality of these patients; the Acute Physiology and Chronic Health Evaluation III prognostic scoring is not validated for this particular sample of the whole population. The observed mortality may simply be higher, because, as Afessa et al1 indeed state, these patients are more severely ill and because their admission to the ICU has been delayed. We believe that recognizing these patients earlier in the night is more important2 than trying to change ICU practices that already appear to be of a high standard.3

Afessa B, Gajic O, Morales IJ, Keegan MT, Peters SG, Hubmayr RD. Association between ICU admission during morning rounds and mortality. Chest. 2009;1366:1489-1495. [CrossRef] [PubMed]
 
Ligtenberg JJ, Arnold LG, Tulleken JJ, van der Werf TS, Zijlstra JG. Hospital mortality rate and length of stay in patients admitted at night to the intensive care unit. Crit Care Med. 2003;3111:2715. [CrossRef] [PubMed]
 
Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA. 2002;28817:2151-2162. [CrossRef] [PubMed]
 

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References

Afessa B, Gajic O, Morales IJ, Keegan MT, Peters SG, Hubmayr RD. Association between ICU admission during morning rounds and mortality. Chest. 2009;1366:1489-1495. [CrossRef] [PubMed]
 
Ligtenberg JJ, Arnold LG, Tulleken JJ, van der Werf TS, Zijlstra JG. Hospital mortality rate and length of stay in patients admitted at night to the intensive care unit. Crit Care Med. 2003;3111:2715. [CrossRef] [PubMed]
 
Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA. 2002;28817:2151-2162. [CrossRef] [PubMed]
 
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