PURPOSE: Studies suggest higher mortality for patients admitted to the hospital during weekends and weeknights. Remote telemonitoring units interventions in the ICU should be greater in severity and quantity during weekends and weeknights.
METHODS: All remote telemonitoring unit physician interventions at five hospitals (1 tertiary academic, 4 community) from 7/1/2005 to 12/31/2005 were reviewed. The data included 233 days(129 weekdays, 104 weekend days). All events were scored into probability of adverse outcome: HIGH(code supervision); MODERATE(communication with physician); LOW(ordering radiographs and labs). The unit operates from 1200 to 0700 on weekdays and 24 hours on the weekend. The interventions were further divided into time categories: A(1200-1800); B(1800-2300); C(2300-0700); D(0700-1200).
RESULTS: During the 233 days of data collection, 1260 patients were admitted into the ICUs requiring 4822 interventions by remote electronic ICU intensivists. There was an average of 3.83 interventions per patient. Total weekday interventions were 3.09/patient and total weekend interventions were 3.16/patient. The majority of interventions occurred during time category C (p< 0.0001 ). There were 2.49 weeknight(time C) interventions per patient and 2.59 weekend night(time C) interventions per patient. Time category A interventions were 1.79 weekday and 1.87 weekend interventions per patient. Time category B interventions were 2.12 weekday and 1.99 weekend interventions per patient. Weekend time category D required 1.68 interventions per patient. The level of intervention was also similar between weekday and weekend time categories. Level 1 time category A interventions were 2.30 weekday and 2.35 weekend interventions per patient. Level 2 time category B interventions were 2.08 weekday and 2.05 weekend interventions per patient. Level 3 time category C interventions were 1.41 weekday and 1.44 weekend interventions per patient.
CONCLUSION: There is no difference in the levels of required intervention based on probability of adverse outcome between weekdays and weekend periods.
CLINICAL IMPLICATIONS: Remote telemonitoring can bridge the gap in maintaining continuous ICU coverage to meet Leapfrog guidelines. Intensivists staffing should be constant between weekdays and weekends with increased staffing between 2300 to 700 hours.
DISCLOSURE: Saadia Faiz, None.