Intensive weekends: Higher death rates at ICUs over weekends

By Dr. Ananya Mandal, MDMar 21 2011

A new study shows that patients admitted to hospital intensive care units on weekends have an increased risk of dying.

The study spanned over eight-years and 245,000 admissions to 41 intensive care units throughout Australia to come to this conclusion. It is published in The Medical Journal of Australia. It also showed that this pattern persisted even after accounting for severity of illness. Authors add that patients admitted to intensive care units between 6pm and 6am on weekdays had a 17 per cent mortality rate, compared with 14 per cent for those admitted during the day. On weekends 20 per cent of patients died, compared with 14 per cent on weekdays.

According to lead researcher Dr Deepak Bhonagiri, who is an intensivist and lecturer in Anaesthesia Intensive Care and Emergency Medicine at Sydney's Liverpool Hospital, intensive care units handled more difficult cases after hours, when people suffered more serious injuries. However what was new was the increased mortality, which was instead seen in planned admissions to intensive care units following elective surgery. He added that a possible explanation was that complications had arisen during elective surgery during the day, leading to delayed admission to intensive care. “Alternatively, these admissions may be of patients whose elective surgical procedures were started at times when a lack of normal facilities, resources and staff have put the patients at increased risk of death,” he said.

Editor Annette Katelaris suggested that even in the well-staffed ICU, the number and seniority of staff declined after hours and that could be a reason. At night, with the consultant on call at home, a senior registrar or fellow is generally in the hospital. Dr. Bhonagiri said more research was needed to determine how the findings related to resource availability and staffing.