J. Driver1, P. Y. Wai1, M. A. Zapf1, A. Kothari1, K. Y. Wolin1, P. C. Kuo1 1Loyola University Chicago Stritch School Of Medicine,Maywood, IL, USA
Introduction: ICU patients comprise the sickest patient population in the hospital. They are presumed to receive unwavering "around the clock" care. However, this assumption has not been previously investigated and anecdotal observations suggest that night time care is variable. To determine potential differences in night time ICU care, patient care parameters were analyzed comparing hourly data from day, evening and night shifts. We hypothesized that variability in ICU care occurs during the night shift and impacts important patient outcomes.
Methods: EPIC electronic medical record data from 15,493 patients in 5 ICUs from 2008-2013 at a major urban academic medical center were retrospectively analyzed for hourly urine output (U/O), mean arterial pressure (MAP), frequency of MD and RN EMR access and total fluid output during day, evening and night shifts. Variation in hourly U/O was selected as a surrogate marker for overall attention to care. ICUs included: CCU, NeuroICU, CardiothoracicICU, MICU, and SICU. Mean night shift values were compared to the mean combined day and evening shift values. Statistical analysis was performed using paired t-tests or linear mixed effect modeling; p values < 0.05 were considered significant.
Results: There was reduced MAP (-0.75 mmHg/hr*) and reduced U/O (-18.9 mL/hr*) during the night shift. Paradoxically, frequency of care giver EMR access was significantly decreased at night (-33.4 times/hr*) and correlated with decreased U/O*, increased length of stay* and increased overall in-hospital mortality*. The model of resident and attending MD coverage and ICU specialty did not correlate with these parameters. (*p<0.0001)
Conclusion: Our results demonstrate that attentiveness (measured by frequency of EMR access) correlated with surrogate care parameters (U/O) and outcome measures (length of stay and mortality). We conclude that variations in night shift ICU care may be due to caregiver inattention. Corrective strategies to increase patient monitoring, such as scheduled night shift ICU team rounding, should be identified.