Out-of-hours discharge from intensive care, in-hospital mortality and intensive care readmission rates: meta-analysis.

Out-of-hours discharge from intensive care, in-hospital mortality and intensive care readmission rates: a systematic review and meta-analysis. [Abstract]
Intensive Care Med. 2018 Jun 25. doi: 10.1007/s00134-018-5245-2.

• Analysis of data from 1,191,178 patients from 18 cohort studies indicates that out-of-hours discharge from an ICU is strongly associated with both in-hospital death and ICU readmission. 
• These effects persisted across all definitions of "out of hours" and across healthcare systems in different geographical locations. Whether these increases in mortality and readmission result from patient differences, differences in care, or a combination remains unclear.

Abstract

Effect of ICU Out-of-Hours Admission on Mortality

The Effect of ICU Out-of-Hours Admission on Mortality: A Systematic Review and Meta-Analysis
Critical Care Medicine. 27 Nov 2017

• Analysis of 16 studies of the impact of out-of-hours adult general ICU admission on patient mortality (16 studies n=902,551). Fourteen studies (n=717,331 patients) reported mortality rates by time of admission and 11 studies (n=835,032 patients) by day of admission. 
• Findings included:
• Admission to ICU at night was not associated with an increased odds of mortality compared with admissions during the day 
• Admissions during the weekend were associated with an increased odds of death compared with ICU admissions during weekdays 
• Absence of a routine overnight on-site intensivist was associated with increased mortality among weekend ICU admissions compared with weekday ICU admissions and nighttime admissions compared with daytime ICU admissions.