0
Correspondence |

Response FREE TO VIEW

Bekele Afessa, MD, FCCP; Ognjen Gajic, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic College of Medicine.

Correspondence to: Bekele Afessa, MD, FCCP, Division of Pulmonary and Critical Care, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: afessa.bekele@mayo.edu


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):1254. doi:10.1378/chest.10-0007
Text Size: A A A
Published online

To the Editor:

We thank Dr Ligtenberg and colleagues for their comments regarding our recent article in CHEST (December 2009)1 that addressed the association between ICU admission during morning round time and mortality. Our article raised a concern about the possibility of suboptimal patient care during morning rounds. Ligtenberg and colleagues believe that the delay in appropriate care prior to ICU admission, rather than suboptimal ICU care, may be the main factor adversely affecting the outcome of patients admitted to ICU during round times. They highlight the importance of early recognition of patients who are deteriorating in the regular hospital ward.

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.

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]
 
Knaus WA, Wagner DP, Draper EA, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991;1006:1619-1636. [CrossRef] [PubMed]
 
Afessa B, Gajic O, Keegan MT. Severity of illness and organ failure assessment in adult intensive care units. Crit Care Clin. 2007;233:639-658. [CrossRef] [PubMed]
 

Figures

Tables

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]
 
Knaus WA, Wagner DP, Draper EA, et al. The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991;1006:1619-1636. [CrossRef] [PubMed]
 
Afessa B, Gajic O, Keegan MT. Severity of illness and organ failure assessment in adult intensive care units. Crit Care Clin. 2007;233:639-658. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543