Admission Time and Outcomes of Patients in a Medical Intensive Care Unit

內科加護病房病患之入院時間對其治療成效之影響

許超群(Chau-Chyun Sheu) ； 蔡忠榮(Jong-Rung Tsai) ； 洪仁宇(Jen-Yu Hung) ； 楊志仁(Chih-Jen Yang) ； 洪信嘉(Hsin-Chia Hung) ； 鍾飲文(Inn-Wen Chong) ； 黃明賢(Ming-Shyan Huang) ； 黃吉志(Jhi-Jhu Hwang)

《The Kaohsiung Journal of Medical Sciences》 23卷8期 (2007/08) Pp. 395-404

摘要

研究顯示於週末或夜間入院至加護病房(ICU)的重症病患其死亡率較高。本研究的目的在評估一個內科ICU（具有病患診治指引，且24小時均有重症醫師on-call,由其帶領醫療團隊每週七天查房，但夜間未留在醫院），是否入ICU時間的不同會影響病患治療的成效。我們將七個月內住院至一大學附設醫院之內科ICU的病患共611名，依其入ICU的時問，分為上班時間（週一至週五08:00-18:00）入院及非上班時間（週一至週五18:00-08:00，及週末的任何時間）入院兩組，比較其病患治療成效的不同。並進一步評估週末、夜問、及一星期中的不同日子入院至ICU，是否會影響病患之住院死亡率。我們的研究結果顯示，於上班時間入院及非上班時間入的兩組病患，其ICU死亡率(27.2% vs．27.4%,P=1.000)及住院死亡率(38.9% vs. 37.6%, P=0.798)均無顯著的差異。兩組病患的ICU住院日數、21天內不需住ICU的日數、住院總日數等在亦無顯著差異。對於需使用呼吸器治療的392位病患，其呼吸器使用的最終結果，亦未因於上班時間或非上班時間入ICU而有所不同。多變項邏輯式迴歸分析則顯示，於調整其他影響因素後的住院死亡率，並未因病患是週末入院、夜間入院、或是一星期中的某一天入院而有顯著的上升。本研究之結論為，於非上班時問入院至我們內科ICU，並不會有較差的臨床治療成效。病患的住院死亡率，並未因其於一天中的某一時段或一星期中的某一天入ICU而有顯著的差異。

關鍵字

住院 ； 重症加護 ； 加護病房 ； 死亡率 ； 時間因素

並列摘要

Studies have shown that weekend or night admissions to intensive care units (ICUs) are associated Studies have shown that weekend or night admissions to intensive care units (ICUs) are associated with increased mortality in critically ill patients. Our study aimed to evaluate the effects of admission time and day on patient outcomes in a medical ICU equipped with patient management guidelines, and staffed by intensivists on call for 24 hours, who led the morning rounds on all days of the week but did not stay in-house overnight. The study enrolled 611 consecutive patients admitted to a 26-bed medical ICU in a university hospital during a 7-month period. We divided them into two groups, which we labeled as ”office hours” (08:00-18:00 on weekdays) and ”non-office hours” (18:00-08:00 on weekdays, and all times on weekends) according to their ICU admission times. The clinical outcomes were compared between the groups. The effects of admission on weekends, at night, and various days of the week on hospital mortality were also evaluated. Our results showed that there were no significant differences in ICU and hospital mortalities between patients admitted during office hours and those admitted during non-office hours (27.2% vs. 27.4%, p=1.000; 38.9% vs. 37.6%, p=0.798). The ICU length of stay, ICU-free time within 21 days, and length of stay in the hospital were also comparable in both groups. Among the 392 patients requiring mechanical ventilation, the ventilator outcomes were not significantly different between those in the office-hour group and the non-office-hour group. Multivariate logistic regression analyses showed that the adjusted odds of hospital mortality were not significantly higher for patients admitted to our ICU on weekends, at night, or on any days of the week. In conclusion, our results showed that non-office-hour admissions to our medical ICU were not associated with poorer ICU, hospital, and ventilator outcomes, compared with office-hour admissions. Neither were time of day and day of the week admissions to our ICU associated with significant differences in hospital mortality.

並列關鍵字

admission ； critical care ； intensive care unit ； mortality ； time factor