Night-time discharge from picu increases the riskof unplanned readmission: An analysis of the anzpic registry

Abstract

Introduction: Night-time discharge from adult intensive care unit (ICU) is associated with high readmission rates and in-hospital mortality. There are limited data regarding the influence of night-time discharge from paediatric ICU (PICU) on readmission and mortality. Objectives/Aims: To study the association between night-time discharge from PICU (8:00 pm to 8:00 am) and 1) unplanned readmission (defined as emergency readmission within 48 hours after ICU discharge) and 2) hospital mortality. Methods: Data from the Australian and New Zealand Paediatric Intensive Care Registry (January 2000 to December 2017) were analysed. All children who survived PICU admission and were discharged to the ward were included. A propensity score methodology (utilising inverse probability of treatment weighting) was used to control for the following covariates between day-time and night-time discharges: age, gender, PIM2 score, elective admission, site, year of discharge (2000-08 vs 2009-17), and length of PICU stay. Results: We included 150,460 discharges of 108,442 children over an 18 year period. The prevalence of night-time discharge declined (p trend<0.001) during the study period: 6.7% (2604 out of 38979) in 2000-05, 6.1% (2946 out of 48428) in 2006-11 and 5.7% (3566 out of 63053) in 2012-17. Overall, the unplanned readmission rate was 1.9% for day-time discharge and 2.4% for nighttime discharge. In a controlled analysis, night-time discharge was associated with higher odds for unplanned readmission [OR (95% CI): 1.45 (1.14-1.85), p=0.002]. There was no significant association between night-time discharge and hospital mortality [OR (95% CI): 1.41; (0.80-2.49), p=0.23]. Conclusion(s): In this large registry study, night-time discharge was strongly associated with early unplanned readmission to PICU, but not with hospital mortality. This has important implications for patient safety, and institutional management and planning of patient flow.L6342802582021-03-02 <br />