There are several factors that influence the outcome of hospitalized patients. We agree with Ligtenberg and colleagues that delays in the recognition of critical illness and in timely intervention are likely to increase the mortality of the critically ill. Such delays may occur at both the regular ward and ICU levels. In our study, we adjusted the mortality rates for the severity of illness measured by the Acute Physiology, Age, and Chronic Health Evaluation (APACHE) III prognostic system.2 Although far from perfect, the APACHE III prognostic system includes the patients’ location before ICU admission, a measure of lead time bias, as one of the predictor variables.2,3 Our study findings highlight the opportunities that exist to improve the outcome of patients admitted during morning round time. These opportunities are likely to exist in both the ICUs and regular wards. We believe the appropriate recognition and triage of patients likely to deteriorate, use of rapid response teams, ensuring optimal supervision in both hospital floors and the ICUs, and reorganizing teaching and patient rounds in ways that do not compromise patient care will improve patient outcome. These interventions require customization to the specific ICU and medical center needs.