Purpose
The relationship between the timing of admission (work-hours or after-hours) to the intensive care unit (ICU) and mortality among surgical ICU (SICU) patients is unclear. This study aimed to investigate whether admission to SICU during after-hours was associated with in-hospital mortality.
Methods
This retrospective cohort study was conducted in a tertiary academic hospital. The data of 571 patients who were admitted to the SICU and whose complete medical records were available were analyzed. Work-hours were defined as 07:00 to 19:00 Monday to Friday, during which the ICU was staffed with intensivists. After-hours were defined as any other time during which the SICU was not staffed with intensivists. The primary outcome measure was in-hospital mortality according to the time of admission (work-hours or after-hours) to the SICU.
Results
A total of 333 patients, were admitted to the SICU during work-hours, and 238 patients after-hours. Unplanned admissions (47.1% vs. 33.3%, p < 0.001), acute physiology and chronic health evaluation II score ≥ 25 (23.9% vs. 11.1%, p < 0.001), the need for ventilator support (34.0% vs. 17.4%, p < 0.001), and the use of vasopressors (50.0% vs. 33.3%, p < 0.001) were significantly higher in the after-hours group compared with the work-hours group. Multivariate analyses revealed that the timing of SICU admission was an independent predictor of in-hospital mortality (odds ratio, 2.526; 95% confidence interval, 1.010–6.320; p = 0.048).
Conclusion
This study showed that admission to the SICU during after-hours was associated with increased in-hospital mortality.

Purpose
The severity of a patient’s medical condition, changing pharmacodynamics and pharmacokinetics, and variability in medication highlight the importance of pharmacological intervention by intensive care unit (ICU) specialized pharmacists.

Methods
Retrospective observations of ICU interventions (omission, changes in medicine, side effects, changes in administration route and dosage, redundancy, and nutritional care) performed between April 2017 and March 2018, determined by an interdisciplinary team (including a specialized ICU pharmacist and a surgical intensivist) on their surgical ICU round, were analyzed. Medicinal prescriptions were screened weekly during the surgical ICU round, and interventions were made if any corrections were necessary. Two days later another team including a surgical intensivist, a pharmacist, and a nutritionist evaluated the patients’ nutritional status (performed weekly).

Results
In the 23-bed ICU, the average number of patients whose prescriptions were examined was 22.38 per surgical round. There were 382 interventions made over 1 year, which was 9.68 interventions per day. The interventions were for nutritional care (161 cases, 42.2%), followed by changes in administration route and dosage (94 cases, 24.6%), omission (59 cases, 15.5%), redundancy (40 cases, 10.4%), changes in medicine (15 cases, 3.9%), and side effects (13 cases, 3.4%).

Conclusion
The conditions of patients admitted to ICU are typically unstable. Pharmacological interventions suggested by a specialized pharmacist may help control the changing medical condition of patients in ICU. A higher participation of pharmacists specialized in working in an interdisciplinary ICU team-based system could lead to safer treatments.

Citations

• Is a FASTHUG enough? Going beyond mnemonics for the next generation of pharmacy learners
  David M. Peters, Katherine L. Jarrell, Mathew R. Johnson, Gretchen M. Brophy
  JACCP: JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY.2023; 6(5): 512.     CrossRef