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Original Research: CRITICAL CARE MEDICINE |

Association Between ICU Admission During Morning Rounds and Mortality

Bekele Afessa, MD, FCCP; Ognjen Gajic, MD, FCCP; Ian J. Morales, MD; Mark T. Keegan, MB; Steve G. Peters, MD, FCCP; Rolf D. Hubmayr, MD, FCCP
Author and Funding Information

Affiliations: From the Division of Pulmonary and Critical Care Medicine (Drs. Afessa, Gajic, Morales, Peters, and Hubmayr), Department of Internal Medicine, and the Division of Critical Care (Dr. Keegan), Department of Anesthesiology, Mayo Clinic, Rochester, MN.

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


For editorial comment see page 1449

Funding/Support: This project was supported by the Office of Faculty Development, Department of Medicine, Mayo Clinic (Rochester, MN) and by grant 1 UL1 RR024150 from the National Center for Research Resources, which is a component of the National Institutes of Health, and the National Institutes of Health Roadmap for Medical Research.

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


© 2009 American College of Chest Physicians


Chest. 2009;136(6):1489-1495. doi:10.1378/chest.09-0529
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Background:  No previous study has evaluated the association between admission to ICUs during round time and patient outcome. The objective of this study was to determine the association between round-time ICU admission and patient outcome.

Methods:  This retrospective study included 49,844 patients admitted from October 1994 to December 2007 to four ICUs (two surgical, one medical, and one multispecialty) of an academic medical center. Of these patients, 3,580 were admitted to the ICU during round time (8:00 am to 10:59 am) and 46,264 were admitted during nonround time (from 1:00 pm to 6:00 am). The medical ICU had 24-h/7-day per week intensivist coverage during the last 2 years of the study. We compared the baseline characteristics and outcome of patients admitted to the ICU between the two groups. Data were abstracted from the acute physiology and chronic health evaluation (APACHE) III database.

Results:  The round-time and non–round-groups were similar in gender, ethnicity, and age. The predicted hospital mortality rate of the round time group was higher (17.4% vs 12.3% predicted, respectively; p < 0.001). The hospital length of stay was similar between the two groups. The round-time group had a higher hospital mortality rate (16.2% vs 8.8%, respectively; p < 0.001). Most of the round-time ICU admissions and deaths occurred in the medical ICU. Round-time admission was an independent risk factor for hospital death (odds ratio, 1.321; 95% CI, 1.178 to 1.481). This independent association was present for the whole study period except for the last 2 years.

Conclusions:  Patients admitted to the ICU during morning rounds have higher severity of illness and mortality rates.


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