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Original Research: Critical Care |

Does Admission During Morning Rounds Increase the Mortality of Patients in the Medical ICU?ICU Admission During Morning Rounds and Mortality

Magali Bisbal, MD; Vanessa Pauly, PhD; Marc Gainnier, MD, PhD; Jean-Marie Forel, MD; Antoine Roch, MD, PhD; Christophe Guervilly, MD; Didier Demory, MD; Jean-Michel Arnal, MD; Fabrice Michel, MD; Laurent Papazian, MD, PhD
Author and Funding Information

From the Aix-Marseille Université (Dr Bisbal and Gainnier), UMR D2; Assistance Publique Hopitaux de Marseille (Drs Bisbal and Gainnier), Hôpital la Timone, Réanimation des Urgences et Médicale; Aix-Marseille Université (Dr Pauly), Laboratoire de Santé Publique EA3279; Assistance Publique Hopitaux de Marseille (Dr Pauly), Hôpitaux Sud, Service de Santé Publique et d’Information Médicale; Aix-Marseille Université (Drs Forel, Roch, Guervilly, Demory, Arnal, Michel, and Papazian), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes CNRS-UMR 6236; and Assistance Publique Hopitaux de Marseille (Drs Forel, Roch, Guervilly, Demory, Arnal, Michel, and Papazian), Hôpital Nord, Réanimation, Marseille, France.

Correspondence to: Magali Bisbal, MD, Réanimation des Urgences et Médicale, Hôpital la Timone, 264 rue Saint Pierre, 13005 Marseille, France; e-mail: magali.bisbal@ap-hm.fr


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(5):1179-1184. doi:10.1378/chest.11-2680
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Background:  Early optimization of treatment is crucial when admitting patients to the ICU and could depend on the organization of the medical team. The aim of this retrospective observational study was to determine whether admissions during morning rounds are independently associated with hospital mortality in a medical ICU.

Methods:  The 3,540 patients admitted from May 2000 to April 2010 to the medical ICU of Sainte Marguerite Hospital in Marseille, France, were divided into two groups based on the time of admission. The non-morning rounds group was admitted between 1:00 pm and 7:59 am, and the morning rounds group was admitted between 8:00 am and 12:59 pm. Hospital mortality (crude and adjusted) was compared between the two groups.

Results:  The 583 patients (16.5%) admitted during morning rounds were older and sicker upon admission compared with those patients admitted during non-morning rounds. The crude hospital mortality was 35.2% (95% CI, 31.4-39.1) in the group of patients admitted during morning rounds and 28.0% (95% CI, 26.4-29.7) in the other group (P < .001). An admission during morning rounds was not independently associated with hospital death (adjusted hazard ratio, 1.10; 95% CI, 0.94-1.28; P = .24).

Conclusions:  Being admitted to the medical ICU during morning rounds is not associated with a poorer outcome than afternoon and night admissions. The conditions of the patients admitted during morning rounds were more severe, which underlines the importance of the ICU team’s availability during this time. Further studies are needed to evaluate if the presence of a specific medical team overnight in the wards would be able to improve patients’ outcome by preventing delayed ICU admission.


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