Impact of intensive care unit admission during handover on mortality: propensity matched cohort study

Midega, Thais Dias; Leite Filho, Newton Carlos Viana; Nassar Jr, Antonio Paulo; Alencar, Roger Monteiro; Capone Neto, Antonio; Ferraz, Leonardo José Rolim; Corrêa, Thiago Domingos

doi:10.31744/einstein_journal/2021AO5748

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Original Article • Einstein (São Paulo) 19 • 2021 • https://doi.org/10.31744/einstein_journal/2021AO5748 copy

Impact of intensive care unit admission during handover on mortality: propensity matched cohort study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To investigate the impact of intensive care unit admission during medical handover on mortality.

Methods:

Post-hoc analysis of data extracted from a prior study aimed at addressing the impacts of intensive care unit readmission on clinical outcomes. This retrospective, single-center, propensity-matched cohort study was conducted in a 41-bed general open-model intensive care unit. Patients were assigned to one of two cohorts according to time of intensive care unit admission: Handover Group (intensive care unit admission between 6:30 am and 7:30 am or 6:30 pm and 7:30 pm) or Control Group (intensive care unit admission between 7:31 am and 6:29 pm or 7:31 pm and 6:29 am). Patients in the Handover Group were propensity-matched to patients in the Control Group at a 1:2 ratio.

Results:

A total of 6,650 adult patients were admitted to the intensive care unit between June 1^st 2013 and May 31^st 2015. Following exclusion of non-eligible participants, 5,779 patients (389; 6.7% and 5,390; 93.3%, Handover and Control Group) were deemed eligible for propensity score matching. Of these, 1,166 were successfully matched (389; 33.4% and 777; 66.6%, Handover and Control Group). Following propensity-score matching, intensive care unit admission during handover was not associated with increased risk of intensive care unit (OR: 1.40; 95%CI: 0.92-2.11; p=0.113) or in-hospital (OR: 1.23; 95%CI: 0.85-1.75; p=0.265) mortality.

Conclusion:

Intensive care unit admission during medical handover did not affect in-hospital mortality in this propensity-matched, single-center cohort study.

Keywords:
Patient handoff; Patient safety; Patient outcome assessment; Intensive care units/statistics & numerical data; Communication; Patient readmission; Patient discharge; Hospital mortality; Health resources/statistics & numerical data

Characteristics		All patients 5,779 (100.0%)	Handover Group 389 (6.7%)	Control Group 5,390 (93.3%)	p value^ p values were calculated as follows:
Age, years		67 (53-80)	67 (52-80)	66 (53-80)	0.483^# # independent t test;
Male		3,268 (56.5)	214 (55)	3,054 (56.7)	0.527^& & χ2 test or
SAPS III score^§ § SAPS III scores ranging from 0 to 217, with higher scores indicating more severe illness and higher risk of death;		43 (33-55)	43 (32-54)	43 (33-55)	0.537^‡ ‡ Mann-Whitney U test;
Reason for ICU admission					0.563^& & χ2 test or
	Medical	3,423 (59.2)	225 (57.8)	3,198 (59.3)
	Surgical	2,356 (40.8)	164 (42.2)	2,192 (40.7)
Admission source					0.741^& & χ2 test or
	Operating room/procedure unit	2,313 (40.0)	155 (39.8)	2,158 (40)
	Emergency department	2,217 (38.4)	148 (38.0)	2,069 (38.4)
	Inpatient unit	557 (9.6)	35 (9.0)	522 (9.7)
	Stepdown unit	377 (6.5)	24 (6.2)	353 (6.5)
	Other^* * other hospital or home care.	315 (5.5)	27 (6.9)	288 (5.3)
Underlying disease
	Hypertension	3,132 (54.2)	210 (54.0)	2,922 (54.2)	0.925^& & χ2 test or
	Diabetes mellitus	1,838 (31.8)	124 (31.9)	1,714 (31.8)	0.979^& & χ2 test or
	Cancer	1,270 (22.0)	97 (24.9)	1,173 (21.8)	0.145^& & χ2 test or
Congestive heart failure		702 (12.2)	47 (12.1)	655 (12.2)	0.719^& & χ2 test or
	COPD	519 (9.0)	36 (9.3)	483 (9.0)	0.854^& & χ2 test or
	Chronic kidney disease requiring long-term dialysis	470 (8.1)	25 (6.4)	445 (8.3)	0.202^& & χ2 test or
	Chronic kidney disease	397 (6.9)	25 (6.4)	372 (6.9)	0.719^& & χ2 test or
	Liver cirrhosis	279 (4.8)	21 (5.4)	258 (4.8)	0.588^& & χ2 test or
Non-operative admission diagnosis					0.849^& & χ2 test or
	Sepsis	1,657 (48.4)	113 (50.2)	1,544 (48.3)
	Cardiovascular	508 (14.8)	38 (16.9)	470 (14.7)
	Neurologic	384 (11.2)	22 (9.8)	362 (11.3)
	Respiratory	326 (9.5)	22 (9.8)	304 (9.5)
	Gastrointestinal	238 (6.7)	17 (7.6)	221 (6.9)
	Metabolic	98 (2.9)	3 (1.3)	95 (3.0)
	Trauma	94 (2.7)	4 (1.8)	90 (2.8)
	Other medical conditions	69 (2.0)	3 (1.3)	66 (2.1)
	Renal diseases	30 (0.9)	2 (0.9)	28 (0.9)
	Hematologic	19 (0.6)	1 (0.4)	18 (0.6)
Operative admission diagnosis					0.748^& & χ2 test or
	Cardiovascular	643 (27.3)	42 (25.6)	601 (27.4)
	Gastrointestinal	545 (23.1)	34 (20.7)	511 (23.3)
	Orthopedic	394 (16.7)	26 (15.9)	368 (16.8)
	Renal	286 (12.1)	25 (15.2)	261 (11.9)
	Neurologic	235 (10.0)	15 (9.1)	220 (10.0)
	Respiratory	203 (8.6)	19 (11.6)	184 (8.4)
	Gynecologic	47 (2.0)	3 (1.8)	44 (2.0)
	Trauma	3 (0.1)	0 (0.0)	3 (0.1)
Support at ICU admission
	Mechanical ventilation	953 (16.5)	57 (14.7)	896 (16.6)	0.312^& & χ2 test or
	Non-invasive ventilation	521 (9.0)	41 (10.5)	480 (8.9)	0.277^& & χ2 test or
	Vasopressors	852 (14.7)	48 (12.3)	804 (14.9)	0.166^& & χ2 test or
	RRT	24 (0.4)	0 (0.0)	24 (0.4)	0.187^& & χ2 test or
Destination upon ICU discharge					0.338^& & χ2 test or
	Stepdown unit	3,152 (54.5)	216 (55.5)	2,936 (54.5)
	Inpatient unit	2,057 (35.6)	134 (34.4)	1,923 (35.7)
	Other/unknown^* * other hospital or home care.	237 (4.1)	11 (2.8)	226 (4.2)

Characteristics		All patients 5,779 (100.0%)	Handover Group 389 (6.7%)	Control Group 5,390 (93.3%)	p value^* * p values were calculated using:
ICU mortality		479 (8.3)	42 (10.8)	437 (8.1)	0.063^† † the χ2 test or
90-day mortality		639 (11.1)	51 (13.1)	588 (10.9)	0.181^† † the χ2 test or
In-hospital mortality		683 (11.8)	55 (14.1)	628 (11.7)	0.142^† † the χ2 test or
Support during ICU stay
	Vasopressors	1,586 (27.4)	98 (25.2)	1,488 (27.6)	0.303^† † the χ2 test or
	Mechanical ventilation	1,401 (24.2)	88 (22.6)	1,313 (24.4)	0.440^† † the χ2 test or
	Non-invasive ventilation	1,438 (24.9)	101 (26.0)	1,337 (24.8)	0.610^† † the χ2 test or
	RRT	566 (9.8)	30 (7.7)	536 (9.9)	0.153^† † the χ2 test or
ICU length of stay, days		2 (1-3)	2 (1-3)	2 (1-3)	0.117^‡ ‡ the Mann-Whitney U test.
Hospital length of stay, days		9 (5-20)	9 (9-18)	9 (5-20)	0.673^‡ ‡ the Mann-Whitney U test.
ICU readmission		576 (10.0)	38 (9.8)	538 (10.0)	0.891^† † the χ2 test or

Characteristics		All patients 1,166 (100.0%)	Handover Group 389 (33.4%)	Control Group 777 (66.6%)	p value^ p values were calculated using:
Age, years		67 (53-80)	67 (52-80)	68 (53-80)	0.880^# # the independent t test;
Male		640 (54.9)	214 (55)	426 (54.8)	0.952^& & the χ2 test or
SAPS III^§		43 (32-55)	43 (32-54)	43 (33-55)	0.621^‡ ‡ the Mann-Whitney U test;
Reason for ICU admission					0.750^& & the χ2 test or
	Medical	682 (58.5)	225 (57.8)	457 (58.8)
	Surgical	484 (41.5)	164 (42.2)	320 (41.2)
Admission source					0.863^& & the χ2 test or
	Operating room/procedure unit	464 (39.8)	155 (39.8)	309 (39.8)
	Emergency department	454 (38.9)	148 (38.0)	306 (39.4)
	Inpatient unit	91 (7.8)	35 (9.0)	56 (7.2)
	Stepdown unit	76 (6.5)	24 (6.2)	52 (6.7)
	Other^* * other hospital or home care.	81 (6.9)	27 (6.9)	54 (6.9)
Underlying disease
	Hypertension	620 (53.2)	210 (54.0)	410 (52.8)	0.694^& & the χ2 test or
	Diabetes mellitus	391 (33.5)	124 (31.9)	267 (34.4)	0.396^& & the χ2 test or
	Cancer	305 (26.2)	97 (24.9)	208 (26.8)	0.502^& & the χ2 test or
	Congestive heart failure	152 (13.0)	47 (12.1)	105 (13.5)	0.494^& & the χ2 test or
	COPD	111 (9.5)	36 (9.3)	75 (9.7)	0.827^& & the χ2 test or
	Chronic kidney disease requiring long-term dialysis	85 (7.3)	25 (6.4)	60 (7.7)	0.422^& & the χ2 test or
	Chronic kidney disease	76 (6.5)	25 (6.4)	51 (6.6)	0.929^& & the χ2 test or
	Liver cirrhosis	61 (5.2)	21 (5.4)	40 (5.1)	0.856^& & the χ2 test or
Non-operative admission diagnosis					0.579^& & the χ2 test or
	Sepsis	332 (48.7)	113 (50.2)	219 (47.9)
	Cardiovascular	105 (15.4)	38 (16.9)	67 (14.7)
	Neurologic	86 (12.6)	22 (9.8)	64 (14.0)
	Respiratory	64 (9.4)	22 (9.8)	42 (9.2)
	Gastrointestinal	44 (6.5)	17 (7.6)	27 (5.9)
	Metabolic	17 (2.5)	3 (1.3)	14 (3.1)
	Trauma	15 (2.2)	4 (1.8)	11 (2.4)
	Other medical conditions	12 (1.8)	3 (1.3)	9 (2.0)
	Renal diseases	3 (0.4)	2 (0.9)	1 (0.2)
	Hematologic	4 (0.6)	1 (0.4)	3 (0.7)
Operative admission diagnosis					0.876^& & the χ2 test or
	Cardiovascular	116 (24.0)	42 (25.6)	74 (23.1)
	Gastrointestinal	102 (21.1)	34 (20.7)	68 (21.3)
	Orthopedic	76 (15.7)	26 (15.9)	50 (15.6)
	Renal	70 (14.5)	25 (15.2)	45 (14.1)
	Neurologic	54 (11.2)	15 (9.1)	39 (12.2)
	Respiratory	52 (10.7)	19 (11.6)	33 (10.3)
	Gynecologic	14 (2.9)	3 (1.8)	11 (3.4)
Support upon ICU admission
	Mechanical ventilation	185 (15.9)	57 (14.7)	128 (16.5)	0.422^& & the χ2 test or
	Non-invasive ventilation	113 (9.7)	41 (10.5)	72 (9.3)	0.488^& & the χ2 test or
	Vasopressors	168 (14.4)	48 (12.3)	120 (15.4)	0.155^& & the χ2 test or
	RRT	2 (0.2)	0 (0.0)	2 (0.3)	0.555^& & the χ2 test or
Destination upon ICU discharge					0.723^& & the χ2 test or
	Stepdown unit	645 (55.3)	216 (55.5)	429 (55.2)
	Inpatient unit	407 (34.9)	134 (34.4)	273 (35.1)
	Other/unknown^* * other hospital or home care.	40 (3.4)	11 (2.8)	29 (3.7)

Characteristics		All patients 1,166 (100.0%)	Handover Group 389 (33.4%)	Control Group 777 (66.6%)	p value^* * p values were calculated using:
ICU mortality		104 (8.9)	42 (10.8)	62 (8.0)	0.111^† † the χ2 test or
90-day mortality		139 (11.9)	51 (13.1)	88 (11.3)	0.375^† † the χ2 test or
In-hospital mortality		147 (12.6)	55 (14.1)	92 (11.8)	0.265^† † the χ2 test or
Support during ICU stay
	Vasopressors	302 (25.9)	98 (25.2)	204 (26.3)	0.696^† † the χ2 test or
	Mechanical ventilation	270 (23.2)	88 (22.6)	182 (23.4)	0.760^† † the χ2 test or
	Non-invasive ventilation	321 (27.5)	101 (26.0)	220 (28.3)	0.397^† † the χ2 test or
	Renal replacement therapy	94 (8.1)	30 (7.7)	64 (8.2)	0.756^† † the χ2 test or
ICU length of stay, days		2 (1-4)	2 (1-3)	2 (1-4)	0.258^‡ ‡ the Mann-Whitney U test.
Hospital length of stay, days		10 (5-20)	9 (5-18)	10 (5-20)	0.689^‡ ‡ the Mann-Whitney U test.
ICU readmission		120 (10.3)	38 (9.8)	82 (10.6)	0.678^† † the χ2 test or

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[1] Corresponding author: Thiago Domingos Corrêa, Avenida Albert Einstein, 627/701, 5th floor – Morumbi Zip code: 05652-900 – São Paulo, SP, Brazil. Phone: (55 11) 2151-1500 E-mail: thiago.correa@einstein.br