In some industries, performance of systems suffers during information exchange time. We wanted to determine if performance during time of information exchange (medical rounds) in the medical ICU was lower than during other times. To assess this, we measured outcomes of patients admitted during rounds (8:00 am to noon) and compared them to patients admitted at all other times.
We examined the APACHE III database of 9165 patients consecutively admitted to our medical ICU over a 7.75-year period starting April 10, 1995. Chi square, student’s t tests and logistic regression analyses were used. All means are ± SD.
Differences in baseline demographics and APACHE III data can be seen in Table 1TABLE 1.
Demographic and APACHE III data for patients by groupRoundsOthersP valueAge (years)63.5±18.261.2±19.6<0.0001Floor transfers46.2%34.9%<0.0001Predicted mortality (%)15.6±19.717.5±22.20.7044Predicted LOS (days)16.2±7.515.2±7.50.2010. The patients admitted during rounds (1627 patients) had a higher mortality rate (20.0 vs 16.0%, P<0.0001) than patients admitted during other times, even when adjusting for admission source and severity of illness (Odds ratio (OR) for mortality 1.58, 95% CI 1.35-1.85). Patients admitted during rounds also had less 28-day ICU free days (20.2 ± 10.8 vs 21.4 ± 9.9 days, P=0.0005), and their hospital LOS was longer (14.3 vs 11.2 days (survivors only), P<0.0001), even when adjusting for APACHE predicted LOS (OR for longer hospitalization 1.175, 1.107-1.246 95% CI).CONCLUSIONS: Admission during the time of medical rounds to our medical ICU is associated with worse outcome compared to admission during other times.CLINICAL IMPLICATIONS: Performance of our ICU system is lower during the time of medical rounds.
I.J. Morales, None.