• Kevin B Laupland, Benoit Misset, Bertrand Souweine, Alexis Tabah, Elie Azoulay, Dany Goldgran-Toledano, Anne-Sylvie Dumenil, Aurélien Vésin, Samir Jamali, Hatem Kallel, Christophe Clec'h, Michael Darmon, Carole Schwebel, and Jean-Francois Timsit.
• University of Grenoble 1 (Joseph Fourier) Integrated Research Center U 823 - Albert Bonniot Institute, Rond Point de la Chantourne 38706, La Tronche Cedex, France.
• Bmc Health Serv Res. 2011 Jan 1;11:321.

BackgroundAlthough the association between mortality and admission to intensive care units (ICU) in the "after hours" (weekends and nights) has been the topic of extensive investigation, the timing of discharge from ICU and outcome has been less well investigated. The objective of this study was to assess effect of timing of admission to and discharge from ICUs and subsequent risk for death.MethodsAdults (≥ 18 years) admitted to French ICUs participating in Outcomerea between January 2006 and November 2010 were included.ResultsAmong the 7,380 patients included, 61% (4,481) were male, the median age was 62 (IQR, 49-75) years, and the median SAPS II score was 40 (IQR, 28-56). Admissions to ICU occurred during weekends (Saturday and Sunday) in 1,708 (23%) cases, during the night (18:00-07:59) in 3,855 (52%), and on nights and/or weekends in 4,659 (63%) cases. Among 5,992 survivors to ICU discharge, 903 (15%) were discharged on weekends, 659 (11%) at night, and 1,434 (24%) on nights and/or weekends. After controlling for a number of co-variates using logistic regression analysis, admission during the after hours was not associated with an increased risk for death. However, patients discharged from ICU on nights were at higher adjusted risk (odds ratio, 1.54; 95% confidence interval, 1.12-2.11) for death.ConclusionsIn this study, ICU discharge at night but not admission was associated with a significant increased risk for death. Further studies are needed to examine whether minimizing night time discharges from ICU may improve outcome.

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