MORE DEATHS IN PATIENTS DISCHARGED FROM ICU IN THE AFTERNOON AND EVENING
Patients discharged from intensive care units (ICUs) to the hospital wards in the afternoon or evening are more likely to die than those discharged during the day, research in the latest Medical Journal of Australia has revealed.
ICU Director at St Vincent's Hospital, Melbourne, Dr John Santamaria, and colleague Dr Antony Tobin, said the hospital records over the 11 years to December 2002 showed a significant increase in mortality rates for patients discharged during the afternoon and overnight nursing shifts.
"Our study shows that, over an 11-year period at our institution, severity of illness on ICU admission increased, afternoon and evening or night discharges became more frequent and such discharges were associated with a statistically significant increase in mortality," Dr Santamaria said.
"A quarter of these deaths occurred within the first three days after ICU discharge."
Changes in hospital size and an increasing demand for ICU beds could be partly responsible for the increased risk, Dr Santamaria said.
"The discharge pattern may be due to a demand for ICU beds in excess of supply, so that the unplanned discharge of the 'least sick or least needy patient' will occur to accommodate an emergency admission," he said.
"There is a general feeling within the intensive care community that more patients are being referred for treatment, that discharges to the ward occur later in the day due to a lack of ward beds and that some people are discharged prematurely to make way for a patient with a more serious illness."
When a patient is transferred from the ICU to a ward, there is a significant reduction in the level of clinical observation and monitoring, with one nurse for every 6-10 patients in a general ward compared with one nurse for every ICU patient.
"There are … fewer medical staff on the wards, with the least numbers of nurses and doctors at night," Dr Santamaria said.
Longer medical and nursing observation of newly discharged patients during the day may help reduce complications, he added.
"It seems likely that hospital 'systems', such as nursing and medical staff numbers, play an important role in the outcome of patients with more severe illness," Dr Santamaria said.
"Changing hospital systems might reverse this negative association. More intensive nursing is one strategy."
The Medical Journal of Australia is a publication of the Australian Medical Association.