1. Role of organisational factors on the ‘weekend effect’ in critically ill patients in Brazil: a retrospective cohort analysis
- Author
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Fernando A. Bozza, Bruno Franco Mazza, Jorge I. F. Salluh, William N. Viana, Haggeas S Fernandes, José Mauro Vieira, Thiago Domingos Corrêa, Roberto Germano Costa, Marcio Soares, Juan Carlos Rosso Verdeal, Fernando Colombari, Marcelo de Oliveira Maia, Thiago Lisboa, Marcus A Ferez, Ana Cláudia P Carvalho, Fernando G. Zampieri, André M. Japiassú, M Knibel, Eliana B Caser, and Michele M. G. Godoy
- Subjects
Male ,Time Factors ,Weekend effect ,Logistic regression ,intensive care unit ,law.invention ,0302 clinical medicine ,Patient Admission ,law ,Medicine ,030212 general & internal medicine ,Hospital Mortality ,Aged, 80 and over ,Intensive care units ,General Medicine ,Middle Aged ,Intensive care unit ,Intensive Care Units ,Workforce ,Female ,weekend effect ,Brazil ,Adult ,medicine.medical_specialty ,Patients ,Critical Illness ,education ,Staffing ,Intensivist ,03 medical and health sciences ,Intensive care ,Humans ,Propensity Score ,Aged ,Retrospective Studies ,organizational factors ,Performance status ,business.industry ,Research ,Intensive Care ,030208 emergency & critical care medicine ,Retrospective cohort study ,Logistic Models ,Emergency medicine ,Multivariate Analysis ,business ,human activities - Abstract
Introduction Higher mortality for patients admitted to intensive care units (ICUs) during the weekends has been occasionally reported with conflicting results that could be related to organisational factors. We investigated the effects of ICU organisational and staffing patterns on the potential association between weekend admission and outcomes in critically ill patients. Methods We included 59 614 patients admitted to 78 ICUs participating during 2013. We defined ‘weekend admission’ as any ICU admission from Friday 19:00 until Monday 07:00. We assessed the association between weekend admission with hospital mortality using a mixed logistic regression model controlling for both patient-level (illness severity, age, comorbidities, performance status and admission type) and ICU-level (decrease in nurse/bed ratio on weekend, full-time intensivist coverage, use of checklists on weekends and number of institutional protocols) confounders. We performed secondary analyses in the subgroup of scheduled surgical admissions. Results A total of 41 894 patients (70.3%) were admitted on weekdays and 17 720 patients (29.7%) on weekends. In univariable analysis, weekend admitted patients had higher ICU (10.9% vs 9.0%, P
- Published
- 2018