Abstract
Background
The association between mortality and off-hour presentation to a medical center has
been studied in relation to various diseases and settings, but little is known of
what the association indicates. This study explored the association in severe trauma
patients among Japanese emergency and critical care centers and their association
with the structural factors of the medical center.
Methods
We conducted a retrospective cohort study using a Japanese, nationwide administrative
database and the annual emergency and critical care centers evaluation report. We
included patients who were seen because of trauma, were at least 15 years old, were
transferred to an emergency and critical care center by ambulance, were admitted to
the intensive care unit, and were discharged between April 1, 2012 and March 31, 2017.
Off-hour care was defined as initial care beginning at all times except 8 am to 6
pm on weekdays and 8 am to noon on Saturdays. We evaluated this topic using the structure-process-outcome
model as proposed by Donabedian. A multilevel logistic regression analysis was performed.
Results
The sample included 111,266 patients from 233 emergency and critical care centers.
The adjusted mortality odds ratio for off-hour care was 0.90 (95% confidence interval:
0.85–0.96; P < .001). In the off-hour care cohort, the immediate availability of an operating
room and off-hours work management including shift work introduction had adjusted
mortality odds ratios of 0.85 (95% confidence interval: 0.74–0.98; P = .02) and 0.85 (95% confidence interval: 0.73–0.99; P = .04), respectively.
Conclusion
In Japan, severe trauma patients who received off-hour care at the emergency and critical
care centers had a decreased in-hospital mortality. The immediate availability of
an operating room and management of off-hours work were contributing structural factors.
Process factors in off-hour care need to be considered in future research on this
topic. This finding may have important applicability to other countries as well.
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Article info
Publication history
Published online: December 27, 2019
Accepted:
October 14,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
