Effect upon mortality of the extension to holidays and weekends of the “ICU without walls” project. A before–after study

array:23 ["pii" => "S2173572716300182" "issn" => "21735727" "doi" => "10.1016/j.medine.2015.09.002" "estado" => "S300" "fechaPublicacion" => "2016-06-01" "aid" => "835" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2016;40:273-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2443 "formatos" => array:3 [ "EPUB" => 177 "HTML" => 1548 "PDF" => 718 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210569115001965" "issn" => "02105691" "doi" => "10.1016/j.medin.2015.09.001" "estado" => "S300" "fechaPublicacion" => "2016-06-01" "aid" => "835" "copyright" => "Elsevier España, S.L.U. y SEMICYUC" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2016;40:273-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4767 "formatos" => array:3 [ "EPUB" => 172 "HTML" => 3548 "PDF" => 1047 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "ORIGINAL" "titulo" => "Efecto sobre la mortalidad de la ampliación a los festivos y fines de semana del proyecto «UCI sin paredes». Estudio before-after" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "273" "paginaFinal" => "279" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Effect upon mortality of the extension to holidays and weekends of the “ICU without walls” project. A before-after study" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1364 "Ancho" => 1502 "Tamanyo" => 68839 ] ] "descripcion" => array:1 [ "es" => "Histograma de distribución de ingresos según el turno de trabajo (p<0,005). Porcentajes." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Abella, V. Enciso, I. Torrejón, C. Hermosa, T. Mozo, R. Molina, D. Janeiro, M. Díaz, M. Homez, F. Gordo, I. Salinas" "autores" => array:11 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Abella" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Enciso" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Torrejón" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Hermosa" ] 4 => array:2 [ "nombre" => "T." "apellidos" => "Mozo" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Molina" ] 6 => array:2 [ "nombre" => "D." "apellidos" => "Janeiro" ] 7 => array:2 [ "nombre" => "M." "apellidos" => "Díaz" ] 8 => array:2 [ "nombre" => "M." "apellidos" => "Homez" ] 9 => array:2 [ "nombre" => "F." "apellidos" => "Gordo" ] 10 => array:2 [ "nombre" => "I." "apellidos" => "Salinas" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173572716300182" "doi" => "10.1016/j.medine.2015.09.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300182?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569115001965?idApp=WMIE" "url" => "/02105691/0000004000000005/v1_201606170053/S0210569115001965/v1_201606170053/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S2173572716300194" "issn" => "21735727" "doi" => "10.1016/j.medine.2015.09.003" "estado" => "S300" "fechaPublicacion" => "2016-06-01" "aid" => "853" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2016;40:280-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2105 "formatos" => array:3 [ "EPUB" => 202 "HTML" => 1222 "PDF" => 681 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Routine invasive strategy in acute coronary syndrome patients with renal dysfunction. Results of the ARIAM-SEMICYUC registry" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "280" "paginaFinal" => "288" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estrategia invasiva de rutina en el síndrome coronario agudo sin elevación del segmento ST con disfunción renal. Resultados del registro ARIAM-SEMICYUC" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1194 "Ancho" => 2266 "Tamanyo" => 126294 ] ] "descripcion" => array:1 [ "en" => "In-hospital mortality and routine invasive strategy (RIS) utilization according to baseline risk." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Latour-Pérez, V. Gómez-Tello, E. de-Miguel-Balsa, A. Llamas-Álvarez, A. Carrillo-López, J.A. Sánchez-Román, J. Ruíz-Ruíz, M.C. Martín-Rodríguez, C.J. Fernández-González, J.A. Fernández-Lozano, C. Picazos Vicente" "autores" => array:12 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Latour-Pérez" ] 1 => array:2 [ "nombre" => "V." "apellidos" => "Gómez-Tello" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "de-Miguel-Balsa" ] 3 => array:2 [ "nombre" => "A." "apellidos" => "Llamas-Álvarez" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Carrillo-López" ] 5 => array:2 [ "nombre" => "J.A." "apellidos" => "Sánchez-Román" ] 6 => array:2 [ "nombre" => "J." "apellidos" => "Ruíz-Ruíz" ] 7 => array:2 [ "nombre" => "M.C." "apellidos" => "Martín-Rodríguez" ] 8 => array:2 [ "nombre" => "C.J." "apellidos" => "Fernández-González" ] 9 => array:2 [ "nombre" => "J.A." "apellidos" => "Fernández-Lozano" ] 10 => array:2 [ "nombre" => "C." "apellidos" => "Picazos Vicente" ] 11 => array:1 [ "colaborador" => "Grupo ARIAM-SEMICYUC" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569115002168" "doi" => "10.1016/j.medin.2015.09.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569115002168?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300194?idApp=WMIE" "url" => "/21735727/0000004000000005/v1_201606250031/S2173572716300194/v1_201606250031/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173572716300200" "issn" => "21735727" "doi" => "10.1016/j.medine.2015.08.007" "estado" => "S300" "fechaPublicacion" => "2016-06-01" "aid" => "840" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Intensiva. 2016;40:266-72" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 3395 "formatos" => array:3 [ "EPUB" => 167 "HTML" => 2260 "PDF" => 968 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Lean techniques to improve flow of critically ill patients in a health region with its epicenter in the intensive care unit of a reference hospital" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "266" "paginaFinal" => "272" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Técnicas «Lean» para la mejora del flujo de los pacientes críticos de una región sanitaria con epicentro en el servicio de medicina intensiva de un hospital de referencia" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3167 "Ancho" => 4318 "Tamanyo" => 899247 ] ] "descripcion" => array:1 [ "en" => "Panel showing the value stream map of the critical patients process. The panel is divided into different parts: the critical patient process is shown at top, while critical patient flow with the updated actual data are shown at bottom. The three projects developed in the period of the study are indicated, with details provided in the text. Finally, the considered health indicators of the critical patients in the ICU are shown." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.M. Sirvent, M. Gil, T. Alvarez, S. Martin, N. Vila, M. Colomer, E. March, P. Loma-Osorio, T. Metje" "autores" => array:9 [ 0 => array:2 [ "nombre" => "J.M." "apellidos" => "Sirvent" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Gil" ] 2 => array:2 [ "nombre" => "T." "apellidos" => "Alvarez" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Martin" ] 4 => array:2 [ "nombre" => "N." "apellidos" => "Vila" ] 5 => array:2 [ "nombre" => "M." "apellidos" => "Colomer" ] 6 => array:2 [ "nombre" => "E." "apellidos" => "March" ] 7 => array:2 [ "nombre" => "P." "apellidos" => "Loma-Osorio" ] 8 => array:2 [ "nombre" => "T." "apellidos" => "Metje" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210569115002016" "doi" => "10.1016/j.medin.2015.08.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569115002016?idApp=WMIE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300200?idApp=WMIE" "url" => "/21735727/0000004000000005/v1_201606250031/S2173572716300200/v1_201606250031/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Effect upon mortality of the extension to holidays and weekends of the “ICU without walls” project. A before–after study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "273" "paginaFinal" => "279" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Abella, V. Enciso, I. Torrejón, C. Hermosa, T. Mozo, R. Molina, D. Janeiro, M. Díaz, M. Homez, F. Gordo, I. Salinas" "autores" => array:11 [ 0 => array:3 [ "nombre" => "A." "apellidos" => "Abella" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "V." "apellidos" => "Enciso" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "I." "apellidos" => "Torrejón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Hermosa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "T." "apellidos" => "Mozo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "R." "apellidos" => "Molina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "D." "apellidos" => "Janeiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "M." "apellidos" => "Díaz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 8 => array:3 [ "nombre" => "M." "apellidos" => "Homez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 9 => array:4 [ "nombre" => "F." "apellidos" => "Gordo" "email" => array:1 [ 0 => "fgordo5@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 10 => array:3 [ "nombre" => "I." "apellidos" => "Salinas" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Grado de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efecto sobre la mortalidad de la ampliación a los festivos y fines de semana del proyecto «UCI sin paredes». Estudio before–after" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1364 "Ancho" => 1502 "Tamanyo" => 69598 ] ] "descripcion" => array:1 [ "en" => "Histogram showing the distribution of admissions according to work shift (P<0.005). Percentages." ] ] ] "textoCompleto" => "IntroductionPatient prognosis, particularly in the case of critically ill individuals, may be influenced by changes in care models occurring during the on-hour and off-hour periods.<a class="elsevierStyleCrossRefs" href="#bib0175">1–4</a> In our setting, and although survival in all the periods was greater than predicted by the severity indicators, admission to the Intensive Care Unit (ICU) during the off-hours period (i.e., patients admitted in the course of the night shift of weekdays, weekends and holidays [WE-H]) was found to be independently associated to mortality when compared with the on-hours group (patients admitted in the course of the morning and afternoon shifts of weekdays).<a class="elsevierStyleCrossRef" href="#bib0195">5</a> These findings are consistent with the published literature.<a class="elsevierStyleCrossRefs" href="#bib0175">1,2</a> A special feature in our case has been the development of the “ICU without walls” project, which is based on the early detection of patients at risk in hospital but outside the ICU, and allows us to intervene early in conventional wards. A before–after study published by our group showed this activity to offer benefit in terms of patient clinical outcome.<a class="elsevierStyleCrossRef" href="#bib0200">6</a> However, the ICU without walls activity was limited to weekdays and was not carried out on WE-H. In the multivariate analysis, the variables independently associated to hospital mortality were found to be the SAPS 3 score and the fact of belonging to the WE-H subgroup.These results support the idea that the early detection of potentially seriously ill patients, and their consequent improved survival,<a class="elsevierStyleCrossRefs" href="#bib0200">6–10</a> could help explain the lesser mortality observed in the on-hours group, where ICU without walls activity was applied.<a class="elsevierStyleCrossRef" href="#bib0195">5</a>The hypothesis of the present study is that extending the ICU without walls project to WE-H has an impact upon mortality among patients who are admitted during that time interval. The primary objective was to determine whether extension to WE-H of the proactive early detection of severity in hospital and the intervention of intensivists in conventional wards and in the emergency room (ICU without walls activity) is associated to a decrease in mortality among patients admitted to the ICU on those days.Patients and methodsA quasi-experimental before–after study was conducted in an adult polyvalent medical-surgical ICU with 8 beds belonging to a second-level hospital with 210 beds. An agreement was reached with hospital management to extend the early detection of severity system to WE-H. This did not really imply any change in the personnel present on WE-H in our center; accordingly, we maintained an intensivist on duty and a second intensivist during 8h in the morning shift–with addition of the ICU without walls activity during the intervention period. A description of the working protocol can be found in the study published by Abella et al.<a class="elsevierStyleCrossRef" href="#bib0195">5</a><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">-In the control group (analyzed in the previous study),<a class="elsevierStyleCrossRef" href="#bib0195">5</a> ICU without walls activity was not carried out, and inclusion was made of the patients admitted to the ICU on WE-H from 1 January 2010 to 30 April 2013.</li><li class="elsevierStyleListItem" id="lsti0010">-In the intervention group, ICU without walls activity was extended to WE-H, and inclusion was made of the patients admitted to the ICU on WE-H from 1 May 2013 to 31 October 2014.</li><li class="elsevierStyleListItem" id="lsti0015">-Patients admitted following scheduled surgery were excluded.</li></ul>An analysis was made of the patient demographic variables (age, sex), origin (emergency care, hospital ward, operating room), type of patient (medical, surgical), reason for admission, comorbidities (defined as comorbidity reflected in the case history, with the present or past administration of treatment for that chronic disease), the SAPS 3 as severity score upon admission, organ failure during admission to the ICU based on the SOFA score, stay in the ICU and in hospital, and mortality in the ICU and in hospital.An analysis was also made of the changes in percentage admissions in the course of the morning, afternoon and night shifts, in order to evaluate the effect of extending the ICU without walls activity to WE-H upon the time of patient admission.The study was approved by the local Ethics Committee. A retrospective analysis of the results was made after implementing the change in management model.Statistical analysisContinuous variables were reported as the mean or median (percentiles), depending on the type of distribution. The Kolmogorov-Smirnov test was used to assess normality of distribution of the continuous variables, and comparisons were made using the nonparametric Mann–Whitney U-test (for variables with a non-normal distribution) or the Student t-test (for variables with a normal distribution). Categorical variables were compared using the chi-squared test.A stepwise multivariate logistic regression analysis was made to explore correlations to mortality in the ICU and assess the possible effect of the intervention group upon outcome, entering all the variables that clinically might be related to survival (sex, age, type of patient, origin, comorbidities and SAPS 3 score). Statistical significance was considered for P<0.05 in all cases.ResultsThe control group comprised 389 patients, while 161 patients were included in the intervention group. There were no differences between the groups in terms of age, sex, origin, type of patient, reason for admission, or organ failure during admission to the ICU (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Although most of the comorbidities were comparable, there was a statistically significant difference in terms of cardiovascular morbidity (present in 49% of the cases in the control group versus in 33% of the cases in the intervention group) (P<0.001). Significant differences were also observed in terms of severity upon admission as assessed by the SAPS 3 scale, with a median score of 52 (percentiles 25–75: 42–63) in the control group versus 48 (percentiles 25–75: 40–56) in the intervention group (P=0.008) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The predicted in-hospital mortality in both groups was 24% and 19%, respectively.The mean stay in the ICU and in hospital after discharge from the ICU showed no differences between the two groups, with a median stay of three days (percentiles 25–75: 2–4) in the ICU in the control group (P=0.15) versus three days (percentiles 25–75: 2–4) in the intervention group, and with a median stay of four days (percentiles 25–75: 1–9) after discharge from the ICU in the control group versus 5 days (percentiles 25–75: 1–9) in the intervention group (P=0.67).The mortality rate in the ICU was 11% in the control group (95% confidence interval [95%CI] 8–14) versus 3% in the intervention group (95%CI 1–7) (P=0.003), with an absolute risk reduction of 8% (95%CI 3–12). The difference referred to in-hospital mortality was also statistically significant, with 14% (95%CI 11–18) in the control group versus 6% (95%CI 3–11) in the intervention group (P=0.013), with an absolute risk reduction of 8% (95%CI 2–12).Variations were observed in the percentage of admissions in the course of the morning, afternoon and night shifts between the two groups. In this regard, an increase in the percentage of admissions was recorded in the morning and afternoon shifts, with a decrease in the night shift, in the intervention group (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>In the multivariate analysis, the only two factors associated to mortality in the ICU were the SAPS 3 score (odds ratio [OR] 1.08; 95%CI 1.06–1.11) and the fact of belonging to the intervention group (OR 0.33; 95%CI 0.12–0.89).DiscussionIn the present study, although patient survival was greater than predicted by the severity indicators employed, those subjects in the intervention group who were admitted to the ICU on WE-H, following extension of the ICU without walls activity to those days, were seen to have a better prognosis than the patients in the control group admitted to the ICU on WE-H in the absence of ICU without walls activity on those days.The ICU without walls protocol has been designed for the early detection of patients at risk in the hospital, outside the ICU, and allows us to intervene before the patient suffers organ failure. Such anticipation has been evaluated in different studies,<a class="elsevierStyleCrossRefs" href="#bib0205">7–13</a> fundamentally based on the fact that life-threatening situations are usually preceded by detectable and preventable physiopathological alterations. This is particularly notorious in the case of time-dependent illnesses such as for example sepsis, acute coronary syndrome or cardiac arrest.<a class="elsevierStyleCrossRefs" href="#bib0240">14–17</a> Specific alarm systems are being developed that combine clinical and laboratory test data, and which offer decision algorithms for initial intervention and the need to inform the ICU.<a class="elsevierStyleCrossRefs" href="#bib0260">18–21</a> The worldwide initiative represented by the Surviving Sepsis Campaign has improved adherence to the clinical practice guides, and has resulted in benefits for patients of this kind, with a shortening of hospital stay and even reductions in mortality.<a class="elsevierStyleCrossRefs" href="#bib0280">22–24</a>This concept of early action has become so important that the recommendations of the European Resuscitation Council for the management of cardiac arrest include as first link in the “chain of survival” the adoption of measures destined to prevent cardiac arrest through the detection of previously manifesting physiopathological alterations.<a class="elsevierStyleCrossRef" href="#bib0295">25</a>The recent systematic review published by Winters et al.<a class="elsevierStyleCrossRef" href="#bib0300">26</a> reveals that many hospitals have developed rapid response teams with the aim of ensuring early detection and rapid response to situations of clinical worsening in patients admitted to conventional wards. Furthermore, different studies have demonstrated a decrease in cardiac arrest and also in mortality as a result of the introduction of such teams.This is the case of the study published by Schmidt et al.,<a class="elsevierStyleCrossRef" href="#bib0235">13</a> which described a time relationship between the introduction of a physiological signs monitoring system and diminished mortality in one hospital (from 7.75% to 6.42%; P<0.0001), with an estimated 397 fewer deaths, while in another center the reduction in mortality was from 7.57% to 6.15% (P<0.0001), with an estimated 372 fewer deaths–these results being a consequence of greater reliability in the recording of vital signs and rapidity in decision making.In the before–after study published by our group, ICU without walls activity resulted in clinical outcome benefits, improved management of the available healthcare resources, and a decrease in mortality among the patients admitted to the ICU during the project implantation period (OR 0.42; 95%CI 0.18–0.98; P=0.04).<a class="elsevierStyleCrossRef" href="#bib0200">6</a>On the other hand, several studies analyzing differences in patient prognosis according to the time of admission to the ICU and even to other hospital areas have reported poorer survival on weekends<a class="elsevierStyleCrossRefs" href="#bib0175">1–4,27–29</a> – though other authors have obtained contradictory results.<a class="elsevierStyleCrossRefs" href="#bib0320">30–33</a> For this reason, we decided to investigate whether there are differences in mortality in our concrete setting according to the time of day of admission to the ICU. In this regard, we distinguished between an on-hours group (i.e., patients admitted in the course of the morning or afternoon shifts on weekdays) and an off-hours group (patients admitted in the course of the night shift, WE-H), and found admission to the off-hours group to be independently associated to mortality.<a class="elsevierStyleCrossRef" href="#bib0195">5</a> At that point we raised the hypothesis that ICU without walls activity could have a causal relation to increased survival on weekdays, and conducted a subgroup analysis contrasting weekdays versus WE-H where no ICU without walls activity was carried out. We found admission on WE-H to be independently associated to mortality. However, the non-interventional nature of the study did not allow us to demonstrate this hypothesis, and we were only able to support a possible relationship between ICU without walls activity and differences in mortality.In the present study we compared the prognosis of patients admitted to intensive care in a group lacking ICU without walls activity on WE-H versus another group in which ICU without walls activity was carried out. The groups were comparable except for cardiovascular comorbidity and severity at the time of admission (both being greater in the control group). This could be explained in terms of the purpose of ICU without walls activity, which seeks early identification and management of patients at risk, i.e., intervention is targeted to less critically ill subjects. In addition to the difference in mortality in the univariate analysis, the logistic regression model found the only two factors associated to mortality in the ICU to be the SAPS 3 score (OR 1.08; 95%CI 1.06–1.11) and the fact of belonging to the intervention group (OR 0.33; 95%CI 0.12–0.89). On the other hand, a change was noted in the distribution of admissions according to work shift–with an increase in the percentage of admissions during the morning and afternoon shifts–thereby facilitating better healthcare resource utilization.As limitations of our study, mention must be made of its single-center nature and the fact that we used the SAPS 3 as a severity indicator at the time of admission to the ICU. In this respect, in populations with a low incidence of organic failure, this scale overestimates predicted mortality, and this could explain the important difference between predicted and real in-hospital mortality.<a class="elsevierStyleCrossRef" href="#bib0340">34</a> The study period in both groups was moreover different, and this could have resulted in minor bias due to greater seasonal mortality and lesser ICU occupation during the summer months. However, there were no differences in mortality in the control group in any of the periods.What we have found in these studies is that the favorable results are attributable to:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020">1.Earlier admission to the ICU of certain patients at risk.</li><li class="elsevierStyleListItem" id="lsti0025">2.Improved patient selection (screening) on deciding admission–some patients being amenable to management in conventional wards without having to occupy an ICU bed, thereby contributing to improve the availability of beds in the Unit.</li><li class="elsevierStyleListItem" id="lsti0030">3.The implementation of plans referred to patient care and limitation of life support measures in the ward, with consensus-based decision making, in order to avoid unnecessary admissions to the ICU.</li><li class="elsevierStyleListItem" id="lsti0035">4.Reduction of in-hospital cardiac arrest.</li></ul>It was not our intention in this study to analyze the underlying causes (undoubtedly of great interest), but only to evaluate the effect of the organizational change made. In order to analyze these factors (as has been done in earlier studies), a larger sample size and the conduction of possibly multicenter trials would be needed.Extension of ICU without walls activity to WE-H results in a decrease in patient mortality both in the ICU and in hospital.Conflicts of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres678037" "titulo" => "Abstract" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Setting" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Patients or participants" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Variables of interest" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Results" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec684009" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres678038" "titulo" => "Resumen" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "abst0040" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0045" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0050" "titulo" => "Ámbito" ] 3 => array:2 [ "identificador" => "abst0055" "titulo" => "Pacientes o participantes" ] 4 => array:2 [ "identificador" => "abst0060" "titulo" => "Variables de interés" ] 5 => array:2 [ "identificador" => "abst0065" "titulo" => "Resultados" ] 6 => array:2 [ "identificador" => "abst0070" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec684008" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-05-19" "fechaAceptado" => "2015-09-01" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec684009" "palabras" => array:6 [ 0 => "Early diagnosis" 1 => "Decision support techniques" 2 => "Hospital rapid response team" 3 => "Outcome" 4 => "Critical care" 5 => "Time admission" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec684008" "palabras" => array:6 [ 0 => "Diagnóstico precoz" 1 => "Herramientas de decisión clínica" 2 => "Equipos de respuesta rápida" 3 => "Pronóstico" 4 => "Cuidados críticos" 5 => "Momento de ingreso" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo determine whether extension to holidays and weekends of the protocol for the early proactive detection of severity in hospital (“ICU without walls” project) results in decreased mortality among patients admitted to the ICU during those days. DesignA quasi-experimental before–after study was carried out. SettingA level 2 hospital with 210 beds and a polyvalent ICU with 8 beds. Patients or participantsThe control group involved no “ICU without walls” activity on holidays or weekends and included those patients admitted to the ICU on those days between 1 January 2010 and 30 April 2013. The intervention group in turn extended the “ICU without walls” activity to holidays and weekends, and included those patients admitted on those days between 1 May 2013 and 31 October 2014. Patients arriving from the operating room after scheduled surgery were excluded. Variables of interestAn analysis was made of the demographic variables (age, gender), origin (emergency room, hospital ward, operating room), type of patient (medical, surgical), reason for admission, comorbidities and SAPS 3 score as a measure of severity upon admission, stay in the ICU and in hospital, and mortality in the ICU and in hospital. ResultsA total of 389 and 161 patients were included in the control group and intervention group, respectively. There were no differences between the 2 groups except as regards cardiovascular comorbidity (49% in the control group versus 33% in the intervention group; P<.001), severity upon admission (median SAPS 3 score 52 [percentiles 25–75: 42–63) in the control group versus 48 [percentiles 25–75: 40–56] in the intervention group; P=.008) and mortality in the ICU (11% in the control group [95% CI 8–14] versus 3% [95% CI 1–7] in the intervention group; P=.003). In the multivariate analysis, the only 2 factors associated to mortality in the ICU were the SAPS 3 score (OR 1.08; 95% CI 1.06–1.11) and inclusion in the intervention group (OR 0.33; 95% CI 0.12–0.89). ConclusionsExtension of the “ICU without walls” activity to holidays and weekends results in a decrease in mortality in the ICU." "secciones" => array:7 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Setting" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Patients or participants" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Variables of interest" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Results" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoEstudiar si la ampliación, a festivos y fines de semana, del protocolo de detección proactiva precoz de gravedad en el hospital y actuación de intensivistas en planta convencional y urgencias (actividad «UCI sin paredes») se asocia a una reducción en la mortalidad de los pacientes ingresados en UCI en esos días. DiseñoEstudio cuasiexperimental before–after. ÁmbitoHospital de nivel 2 con 210 camas en funcionamiento y UCI polivalente con 8 camas. Pacientes o participantesEn el grupo control, donde no se realiza la actividad «UCI sin paredes» los fines de semana ni festivos, se incluyeron los pacientes ingresados en la UCI esos días del 1 de enero de 2010 al 30 de abril de 2013. En el grupo intervención se amplió la actividad «UCI sin paredes» a los fines de semana y festivos y se incluyeron los pacientes ingresados esos días del 1 de mayo de 2013 al 31 de octubre de 2014. Se excluyeron los pacientes procedentes de quirófano tras una cirugía programada. Variables de interésSe analizaron las variables demográficas (edad, sexo), la procedencia (urgencias, planta de hospitalización, quirófano), el tipo de paciente (médico, quirúrgico), el motivo de ingreso, las comorbilidades y el SAPS 3 como puntuación de gravedad al ingreso, estancia en UCI y hospitalaria, además de la mortalidad en la UCI y en el hospital. ResultadosSe incluyeron en el grupo control 389 pacientes, y 161 en el grupo intervención. No se encontraron diferencias entre ambos grupos, salvo en la comorbilidad cardiovascular (un 49% en el grupo control frente a un 33% en el grupo intervención; p<0,001), en la gravedad al ingreso medida mediante el SAPS 3 (mediana de 52 [percentiles 25–75: 42–63] en el grupo control frente a 48 [percentiles 25–75: 40–56] en el grupo intervención; p=0,008) y en la mortalidad en UCI, que fue de un 11% en el grupo control (IC 95% 8 a 14) frente al 3% (IC 95% 1 a 7) en el grupo intervención (p=0,003). En el análisis multivariable, los 2 únicos factores asociados con la mortalidad en UCI fueron: SAPS 3 (OR 1,08; IC 95% 1,06–1,11) y el pertenecer al grupo intervención (OR 0,33; IC 95% 0,12–0,89). ConclusionesLa ampliación de la actividad «UCI sin paredes» a los fines de semana y festivos conlleva un descenso en la mortalidad en la UCI." "secciones" => array:7 [ 0 => array:2 [ "identificador" => "abst0040" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0045" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0050" "titulo" => "Ámbito" ] 3 => array:2 [ "identificador" => "abst0055" "titulo" => "Pacientes o participantes" ] 4 => array:2 [ "identificador" => "abst0060" "titulo" => "Variables de interés" ] 5 => array:2 [ "identificador" => "abst0065" "titulo" => "Resultados" ] 6 => array:2 [ "identificador" => "abst0070" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Abella A, Enciso V, Torrejón I, Hermosa C, Mozo T, Molina R, et al. Efecto sobre la mortalidad de la ampliación a los festivos y fines de semana del proyecto «UCI sin paredes». Estudio before–after. Med Intensiva. 2016;40:273–279." ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1364 "Ancho" => 1502 "Tamanyo" => 69598 ] ] "descripcion" => array:1 [ "en" => "Histogram showing the distribution of admissions according to work shift (P<0.005). Percentages." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "SAPS 3: simplified acute physiology score; SOFA: sequential organ failure assessment." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control group (n=389) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Intervention group (n=161) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">P-value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age in years, median (percentiles 25–75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (52–76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (53–75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.82 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.65 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Males \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">236 (61) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">101 (63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Females \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">153 (39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 (37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Origin, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.26 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Emergency room \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">283 (73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">113 (70) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ward \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Operating room \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Type of patient, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Medical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">323 (83) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">125 (78) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Surgical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 (22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Reason for admission, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.08 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sepsis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 (15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ischemic heart disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">106 (27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiac arrest \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other medical reason \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">168 (44) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61 (38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Postoperative \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 (12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Comorbidities, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiovascular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">189 (49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Respiratory \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84 (22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.41 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Renal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.34 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hepatic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Oncological \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 (13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.71 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Endocrine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">107 (28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="char" valign="top">Organ failure developing during stay (SOFA scale)</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiovascular failure, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">159 (41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 (42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.77 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Respiratory failure, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">184 (47) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 (41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Renal failure, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">31 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.12 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SAPS 3, median (percentiles 25–75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 (42–63) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 (40–56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1112742.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic variables of the two groups." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:34 [ 0 => array:3 [ "identificador" => "bib0175" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Increased mortality associated with after-hours and weekend admission to the intensive care unit: a retrospective analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Bhonagiri" 1 => "D.V. Pilcher" 2 => "M.J. Bailey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med J Aust" "fecha" => "2011" "volumen" => "194" "paginaInicial" => "287" "paginaFinal" => "292" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21426282" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0180" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hospital mortality is associated with ICU admission time" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H.A. Kuijsten" 1 => "S. Brinkman" 2 => "I.A. Meynaar" 3 => "P.E. Spronk" 4 => "J.I. van der Spoel" 5 => "R.J. Bosman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-010-1918-1" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2010" "volumen" => "36" "paginaInicial" => "1765" "paginaFinal" => "1771" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20549184" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0185" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Weekend hospitalization and additional risk of death: an analysis of inpatient data" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Freemantle" 1 => "M. Richardson" 2 => "J. Wood" 3 => "D. Ray" 4 => "S. Khosla" 5 => "D. Shahian" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1258/jrsm.2012.120009" "Revista" => array:6 [ "tituloSerie" => "J R Soc Med" "fecha" => "2012" "volumen" => "105" "paginaInicial" => "74" "paginaFinal" => "84" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22307037" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0190" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incidence of “never events” among weekend admissions versus week day admissions to US hospitals: national analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F.J. Attenello" 1 => "T. Wen" 2 => "S.Y. Cen" 3 => "A. Ng" 4 => "M. Kim-Tenser" 5 => "N. Sanossian" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.h1460" "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2015" "volumen" => "350" "paginaInicial" => "h1460" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25876878" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0195" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efecto del momento de ingreso sobre el pronóstico de los pacientes en la Unidad de Cuidados Intensivos: on-hours vs off-hours" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Abella" 1 => "C. Hermosa" 2 => "V. Enciso" 3 => "I. Torrejón" 4 => "R. Molina" 5 => "I. Salinas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2014.11.009" "Revista" => array:3 [ "tituloSerie" => "Med Intensiva" "fecha" => "2015" "itemHostRev" => array:3 [ "pii" => "S0264410X12016301" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0200" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ICU without walls project. Effect of the early detection of patients at risk" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Abella Álvarez" 1 => "I. Torrejo¿n Pérez" 2 => "V. Enciso Calderón" 3 => "C. Hermosa Gelbard" 4 => "J.J. Sicilia Urban" 5 => "M. Ruiz Grinspan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2012.08.006" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2013" "volumen" => "37" "paginaInicial" => "12" "paginaFinal" => "18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23059055" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0205" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multicenter development and validation of a risk stratification tool for ward patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.M. Churpek" 1 => "T.C. Yuen" 2 => "C. Winslow" 3 => "A.A. Robicsek" 4 => "D.O. Meltzer" 5 => "R.D. Gibbons" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201406-1022OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2014" "volumen" => "190" "paginaInicial" => "649" "paginaFinal" => "655" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25089847" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0210" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "SECI (Servicio Extendido de Cuidados Intensivos): mirando fuera de la UCI" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.S. Holanda Peña" 1 => "M.J. Domínguez Artiga" 2 => "E. Ots Ruiz" 3 => "M.I. Lorda de los Ri¿os" 4 => "A. Castellanos Ortega" 5 => "F. Ortiz Melón" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2011.03.012" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2011" "volumen" => "35" "paginaInicial" => "349" "paginaFinal" => "353" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21571395" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0215" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aplicación de las técnicas de información y comunicación para la detección de pacientes de alto riesgo: alarmas de rápida asistencia. Estudio piloto del proyecto ARA-Son Llàtzer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Soci¿as Crespi¿" 1 => "G. Heras la Calle" 2 => "V.M. Estrada Rodri¿guez" 3 => "A. García Sánchez" 4 => "P. Ibáñez-Luci¿a" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2012.04.001" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2013" "volumen" => "37" "paginaInicial" => "19" "paginaFinal" => "26" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22683046" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0220" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impacto de un nuevo modelo de Medicina Intensiva sobre la asistencia en un servicio de Medicina Intensiva" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. González Castro" 1 => "F. Ortiz Melón" 2 => "B. Suberviola" 3 => "M.S. Holanda Peña" 4 => "M.J. Domínguez" 5 => "C. Blanco Huelga" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2012.06.003" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2013" "volumen" => "37" "paginaInicial" => "27" "paginaFinal" => "32" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22959859" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0225" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rapid response teams: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P.S. Chan" 1 => "R. Jain" 2 => "B.K. Nallmothu" 3 => "R.A. Berg" 4 => "C. Sasson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Adv Intern Med" "fecha" => "2010" "volumen" => "170" "paginaInicial" => "18" "paginaFinal" => "26" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0230" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rapid response team-triggered procalcitonin measurement predicts infectious intensive care unit transfers" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.G. Wunderink" 1 => "E.R. Diederich" 2 => "M.P. Caramez" 3 => "H.K. Donnelly" 4 => "S.D. Norwood" 5 => "A. Kho" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e31824fc027" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2012" "volumen" => "40" "paginaInicial" => "2090" "paginaFinal" => "2095" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22564964" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0235" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of introducing an electronic physiological surveillance system on hospital mortality" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.E. Schmidt" 1 => "P. Meredith" 2 => "D.R. Prytherch" 3 => "D. Watson" 4 => "V. Watson" 5 => "R.M. Killen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmjqs-2014-003073" "Revista" => array:6 [ "tituloSerie" => "BMJ Qual Saf" "fecha" => "2015" "volumen" => "24" "paginaInicial" => "10" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25249636" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0240" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical antecedents to in-hospital cardiopulmonary arrest" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Schein" 1 => "N. Hazday" 2 => "M. Pena" 3 => "B.H. Ruben" 4 => "C.L. Sprung" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "1990" "volumen" => "98" "paginaInicial" => "1388" "paginaFinal" => "1392" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2245680" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0245" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physiological values and procedures in the 24h before ICU admission from the ward" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.R. Goldhill" 1 => "S.A. White" 2 => "A. Sumner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Anaesthesia" "fecha" => "1999" "volumen" => "54" "paginaInicial" => "529" "paginaFinal" => "534" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10403864" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0250" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Duration of life-threatening antecedents prior to intensive care admission" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.M. Hillman" 1 => "P.J. Bristow" 2 => "T. Chey" 3 => "K. Daffurn" 4 => "T. Jacques" 5 => "S.L. Norman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-002-1496-y" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2002" "volumen" => "28" "paginaInicial" => "1629" "paginaFinal" => "1634" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12415452" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0255" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparison of antecedents to cardiac arrests, deaths and emergency intensive care admissions in Australia and New Zealand, and in the United Kingdom – The ACADEMIA study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Kause" 1 => "G. Smith" 2 => "D. Prytherch" 3 => "M. Parr" 4 => "A. Flabouris" 5 => "K. Hillman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resuscitation.2004.05.016" "Revista" => array:6 [ "tituloSerie" => "Resuscitation" "fecha" => "2004" "volumen" => "62" "paginaInicial" => "275" "paginaFinal" => "282" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15325446" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0260" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guías de Práctica Clínica de la Sociedad Europea de Cardiología (ESC). Manejo del infarto agudo de miocardio en pacientes con elevación persistente del segmento ST" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "F. Van der Werf" 1 => "J. Bax" 2 => "A. Betriu" 3 => "C. Blomstrom-Lundqvist" 4 => "F. Crea" 5 => "V. Falk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0300-8932(09)70373-2" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cardiol" "fecha" => "2009" "volumen" => "62" "paginaInicial" => "e1" "paginaFinal" => "e47" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23040488" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0265" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical practice guideline: endpoints of resuscitation in trauma patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Tisherman" 1 => "P. Barie" 2 => "F. Bokhari" 3 => "J. Bonadies" 4 => "B. Daley" 5 => "L. Diebel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Trauma" "fecha" => "2004" "volumen" => "57" "paginaInicial" => "898" "paginaFinal" => "912" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15514553" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0270" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.C. Jauch" 1 => "J.L. Saver" 2 => "H.P. Adams Jr." 3 => "A. Bruno" 4 => "J.J. Connors" 5 => "B.M. Demaerschalk" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/STR.0b013e318284056a" "Revista" => array:6 [ "tituloSerie" => "Stroke" "fecha" => "2013" "volumen" => "44" "paginaInicial" => "870" "paginaFinal" => "947" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23370205" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0275" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.P. Dellinger" 1 => "M.M. Levy" 2 => "A. Rhodes" 3 => "D. Annane" 4 => "H. Gerlach" 5 => "S.M. Opal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-012-2769-8" "Revista" => array:7 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2013" "volumen" => "39" "paginaInicial" => "165" "paginaFinal" => "228" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23361625" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0264410X14009359" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0280" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of treatments for severe sepsis: a prospective, multicenter, observational study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Ferrer" 1 => "A. Artigas" 2 => "D. Suarez" 3 => "E. Palencia" 4 => "M.M. Levy" 5 => "A. Arenzana" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.200812-1912OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2009" "volumen" => "180" "paginaInicial" => "861" "paginaFinal" => "866" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19696442" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0285" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Ferrer" 1 => "A. Artigas" 2 => "M.M. Levy" 3 => "J. Blanco" 4 => "G. González-Díaz" 5 => "J. Garnacho-Montero" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.299.19.2294" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2008" "volumen" => "299" "paginaInicial" => "2294" "paginaFinal" => "2303" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18492971" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0290" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of the Surviving Sepsis Campaign protocols on hospital length of stay and mortality in septic shock patients: results of a three-year follow-up quasi-experimental study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Castellanos Ortega" 1 => "B. Suberviola" 2 => "L. García Astudillo" 3 => "M.S. Holanda" 4 => "F. Ortiz" 5 => "J. Llorca" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/CCM.0b013e3181d455b6" "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2010" "volumen" => "38" "paginaInicial" => "1036" "paginaFinal" => "1043" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20154597" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0295" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.P. Nolan" 1 => "J. Soar" 2 => "D.A. Zideman" 3 => "D. Biarent" 4 => "L.L. Bossaert" 5 => "C. Deakin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.resuscitation.2010.08.021" "Revista" => array:6 [ "tituloSerie" => "Resuscitation" "fecha" => "2010" "volumen" => "81" "paginaInicial" => "1219" "paginaFinal" => "1276" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20956052" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0300" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rapid-response systems as a patient safety strategy: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B.D. Winters" 1 => "S.J. Weaver" 2 => "E.R. Pfoh" 3 => "T. Yang" 4 => "J.C. Pham" 5 => "S.M. Dy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/0003-4819-158-5-201303051-00009" "Revista" => array:7 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2013" "volumen" => "158" "numero" => "5 (Pt 2)" "paginaInicial" => "417" "paginaFinal" => "425" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23460099" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0305" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Off-hour presentation and outcomes in patients with acute myocardial infarction: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Sorita" 1 => "A. Ahmed" 2 => "S.R. Starr" 3 => "K.M. Thompson" 4 => "D.A. Reed" 5 => "L. Prokop" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2014" "volumen" => "348" "paginaInicial" => "f7393" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24452368" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0310" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Day of week of procedure and 30 day mortality for elective surgery: retrospective analysis of hospital episode statistics" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Aylin" 1 => "R. Alexandrescu" 2 => "M.H. Jen" 3 => "E.K. Mayer" 4 => "A. Bottle" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "BMJ" "fecha" => "2013" "volumen" => "346" "paginaInicial" => "f2424" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23716356" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673615608224" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0315" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Weekend admission as an independent predictor of mortality: an analysis of Scottish hospital admissions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.E. Handel" 1 => "S.V. Patel" 2 => "A. Skingsley" 3 => "K. Bramley" 4 => "R. Sobieski" 5 => "S.V. Ramagopalan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmjopen-2012-001789" "Revista" => array:5 [ "tituloSerie" => "BMJ Open" "fecha" => "2012" "volumen" => "2" "paginaInicial" => "e001789" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23135542" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0320" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of admission time on mortality in an intensive care unit in Mainland China: a propensity score matching analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.J. Ju" 1 => "G.W. Tu" 2 => "Y. Han" 3 => "H.Y. He" 4 => "Y.Z. He" 5 => "H.L. Mao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc13053" "Revista" => array:5 [ "tituloSerie" => "Crit Care" "fecha" => "2013" "volumen" => "17" "paginaInicial" => "R230" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24112558" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0325" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Weekend versus weekday hospital deaths: analysis of in-patient data in a Nigerian tertiary healthcare center" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B.O. Nwosu" 1 => "N.O. Eke" 2 => "A. Obi-Nwosu" 3 => "O.J. Osakwe" 4 => "C.O. Eke" 5 => "N.P. Obi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/1119-3077.116900" "Revista" => array:6 [ "tituloSerie" => "Niger J Clin Pract" "fecha" => "2013" "volumen" => "16" "paginaInicial" => "501" "paginaFinal" => "504" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23974747" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0330" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mortality associated with timing of admission to and discharge from ICU: a retrospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.B. Laupland" 1 => "B. Misset" 2 => "B. Souweine" 3 => "A. Tabah" 4 => "E. Azoulay" 5 => "D. Goldgran-Toledano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1472-6963-11-321" "Revista" => array:5 [ "tituloSerie" => "BMC Health Serv Res" "fecha" => "2011" "volumen" => "11" "paginaInicial" => "321" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22115194" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0335" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between time of admission to the ICU and mortality: a systematic review and metaanalysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Cavallazzi" 1 => "P.E. Marik" 2 => "A. Hirani" 3 => "M. Pachinburavan" 4 => "T.S. Vasu" 5 => "B.E. Leiby" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.09-3018" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2010" "volumen" => "138" "paginaInicial" => "68" "paginaFinal" => "75" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20418364" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0340" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "External validation of the simplified acute physiology score (SAPS) 3 in Spain" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. López-Caler" 1 => "M. Garci¿a-Delgado" 2 => "J. Carpio-Sanz" 3 => "J. Alvarez-Rodri¿guez" 4 => "E. Aguilar-Alonso" 5 => "E. Castillo-Lorente" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2013.06.003" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2014" "volumen" => "38" "paginaInicial" => "288" "paginaFinal" => "296" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24053903" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735727/0000004000000005/v1_201606250031/S2173572716300182/v1_201606250031/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004000000005/v1_201606250031/S2173572716300182/v1_201606250031/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300182?idApp=WMIE"]

Statistics

Original

Effect upon mortality of the extension to holidays and weekends of the “ICU without walls” project. A before–after study

Efecto sobre la mortalidad de la ampliación a los festivos y fines de semana del proyecto «UCI sin paredes». Estudio before–after

A. Abellaa, V. Encisoa, I. Torrejóna, C. Hermosaa, T. Mozoa, R. Molinaa, D. Janeiroa, M. Díaza, M. Homeza, F. Gordoa,b,

Corresponding author

fgordo5@gmail.com

Corresponding author.

, I. Salinasa,b

a Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, Spain

b Grado de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain

Read

6554

Times
was read the article

2523

Total PDF

4031

Total HTML

Share statistics

 array:23 [
  "pii" => "S2173572716300182"
  "issn" => "21735727"
  "doi" => "10.1016/j.medine.2015.09.002"
  "estado" => "S300"
  "fechaPublicacion" => "2016-06-01"
  "aid" => "835"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Med Intensiva. 2016;40:273-9"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2443
    "formatos" => array:3 [
      "EPUB" => 177
      "HTML" => 1548
      "PDF" => 718
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0210569115001965"
      "issn" => "02105691"
      "doi" => "10.1016/j.medin.2015.09.001"
      "estado" => "S300"
      "fechaPublicacion" => "2016-06-01"
      "aid" => "835"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; y SEMICYUC"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Med Intensiva. 2016;40:273-9"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 4767
        "formatos" => array:3 [
          "EPUB" => 172
          "HTML" => 3548
          "PDF" => 1047
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
        "titulo" => "Efecto sobre la mortalidad de la ampliaci&#243;n a los festivos y fines de semana del proyecto &#171;UCI sin paredes&#187;&#46; Estudio <span class="elsevierStyleItalic">before-after</span>"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "273"
            "paginaFinal" => "279"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Effect upon mortality of the extension to holidays and weekends of the &#8220;ICU without walls&#8221; project&#46; A before-after study"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1364
                "Ancho" => 1502
                "Tamanyo" => 68839
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Histograma de distribuci&#243;n de ingresos seg&#250;n el turno de trabajo &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#46; Porcentajes&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "A&#46; Abella, V&#46; Enciso, I&#46; Torrej&#243;n, C&#46; Hermosa, T&#46; Mozo, R&#46; Molina, D&#46; Janeiro, M&#46; D&#237;az, M&#46; Homez, F&#46; Gordo, I&#46; Salinas"
            "autores" => array:11 [
              0 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Abella"
              ]
              1 => array:2 [
                "nombre" => "V&#46;"
                "apellidos" => "Enciso"
              ]
              2 => array:2 [
                "nombre" => "I&#46;"
                "apellidos" => "Torrej&#243;n"
              ]
              3 => array:2 [
                "nombre" => "C&#46;"
                "apellidos" => "Hermosa"
              ]
              4 => array:2 [
                "nombre" => "T&#46;"
                "apellidos" => "Mozo"
              ]
              5 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "Molina"
              ]
              6 => array:2 [
                "nombre" => "D&#46;"
                "apellidos" => "Janeiro"
              ]
              7 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "D&#237;az"
              ]
              8 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Homez"
              ]
              9 => array:2 [
                "nombre" => "F&#46;"
                "apellidos" => "Gordo"
              ]
              10 => array:2 [
                "nombre" => "I&#46;"
                "apellidos" => "Salinas"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2173572716300182"
          "doi" => "10.1016/j.medine.2015.09.002"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300182?idApp=WMIE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569115001965?idApp=WMIE"
      "url" => "/02105691/0000004000000005/v1_201606170053/S0210569115001965/v1_201606170053/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S2173572716300194"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2015.09.003"
    "estado" => "S300"
    "fechaPublicacion" => "2016-06-01"
    "aid" => "853"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Med Intensiva. 2016;40:280-8"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2105
      "formatos" => array:3 [
        "EPUB" => 202
        "HTML" => 1222
        "PDF" => 681
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
      "titulo" => "Routine invasive strategy in acute coronary syndrome patients with renal dysfunction&#46; Results of the ARIAM-SEMICYUC registry"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "280"
          "paginaFinal" => "288"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Estrategia invasiva de rutina en el s&#237;ndrome coronario agudo sin elevaci&#243;n del segmento ST con disfunci&#243;n renal&#46; Resultados del registro ARIAM-SEMICYUC"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1194
              "Ancho" => 2266
              "Tamanyo" => 126294
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">In-hospital mortality and routine invasive strategy &#40;RIS&#41; utilization according to baseline risk&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Latour-P&#233;rez, V&#46; G&#243;mez-Tello, E&#46; de-Miguel-Balsa, A&#46; Llamas-&#193;lvarez, A&#46; Carrillo-L&#243;pez, J&#46;A&#46; S&#225;nchez-Rom&#225;n, J&#46; Ru&#237;z-Ru&#237;z, M&#46;C&#46; Mart&#237;n-Rodr&#237;guez, C&#46;J&#46; Fern&#225;ndez-Gonz&#225;lez, J&#46;A&#46; Fern&#225;ndez-Lozano, C&#46; Picazos Vicente"
          "autores" => array:12 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Latour-P&#233;rez"
            ]
            1 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "G&#243;mez-Tello"
            ]
            2 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "de-Miguel-Balsa"
            ]
            3 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Llamas-&#193;lvarez"
            ]
            4 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Carrillo-L&#243;pez"
            ]
            5 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "S&#225;nchez-Rom&#225;n"
            ]
            6 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Ru&#237;z-Ru&#237;z"
            ]
            7 => array:2 [
              "nombre" => "M&#46;C&#46;"
              "apellidos" => "Mart&#237;n-Rodr&#237;guez"
            ]
            8 => array:2 [
              "nombre" => "C&#46;J&#46;"
              "apellidos" => "Fern&#225;ndez-Gonz&#225;lez"
            ]
            9 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "Fern&#225;ndez-Lozano"
            ]
            10 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Picazos Vicente"
            ]
            11 => array:1 [
              "colaborador" => "Grupo ARIAM-SEMICYUC"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210569115002168"
        "doi" => "10.1016/j.medin.2015.09.008"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569115002168?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300194?idApp=WMIE"
    "url" => "/21735727/0000004000000005/v1_201606250031/S2173572716300194/v1_201606250031/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S2173572716300200"
    "issn" => "21735727"
    "doi" => "10.1016/j.medine.2015.08.007"
    "estado" => "S300"
    "fechaPublicacion" => "2016-06-01"
    "aid" => "840"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Med Intensiva. 2016;40:266-72"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3395
      "formatos" => array:3 [
        "EPUB" => 167
        "HTML" => 2260
        "PDF" => 968
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
      "titulo" => "Lean techniques to improve flow of critically ill patients in a health region with its epicenter in the intensive care unit of a reference hospital"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "266"
          "paginaFinal" => "272"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "T&#233;cnicas &#171;Lean&#187; para la mejora del flujo de los pacientes cr&#237;ticos de una regi&#243;n sanitaria con epicentro en el servicio de medicina intensiva de un hospital de referencia"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 3167
              "Ancho" => 4318
              "Tamanyo" => 899247
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Panel showing the value stream map of the critical patients process&#46; The panel is divided into different parts&#58; the critical patient process is shown at top&#44; while critical patient flow with the updated actual data are shown at bottom&#46; The three projects developed in the period of the study are indicated&#44; with details provided in the text&#46; Finally&#44; the considered health indicators of the critical patients in the ICU are shown&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46;M&#46; Sirvent, M&#46; Gil, T&#46; Alvarez, S&#46; Martin, N&#46; Vila, M&#46; Colomer, E&#46; March, P&#46; Loma-Osorio, T&#46; Metje"
          "autores" => array:9 [
            0 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "Sirvent"
            ]
            1 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Gil"
            ]
            2 => array:2 [
              "nombre" => "T&#46;"
              "apellidos" => "Alvarez"
            ]
            3 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Martin"
            ]
            4 => array:2 [
              "nombre" => "N&#46;"
              "apellidos" => "Vila"
            ]
            5 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Colomer"
            ]
            6 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "March"
            ]
            7 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Loma-Osorio"
            ]
            8 => array:2 [
              "nombre" => "T&#46;"
              "apellidos" => "Metje"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0210569115002016"
        "doi" => "10.1016/j.medin.2015.08.005"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210569115002016?idApp=WMIE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300200?idApp=WMIE"
    "url" => "/21735727/0000004000000005/v1_201606250031/S2173572716300200/v1_201606250031/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
    "titulo" => "Effect upon mortality of the extension to holidays and weekends of the &#8220;ICU without walls&#8221; project&#46; A before&#8211;after study"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "273"
        "paginaFinal" => "279"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "A&#46; Abella, V&#46; Enciso, I&#46; Torrej&#243;n, C&#46; Hermosa, T&#46; Mozo, R&#46; Molina, D&#46; Janeiro, M&#46; D&#237;az, M&#46; Homez, F&#46; Gordo, I&#46; Salinas"
        "autores" => array:11 [
          0 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Abella"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "V&#46;"
            "apellidos" => "Enciso"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "I&#46;"
            "apellidos" => "Torrej&#243;n"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "C&#46;"
            "apellidos" => "Hermosa"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "T&#46;"
            "apellidos" => "Mozo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "R&#46;"
            "apellidos" => "Molina"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "D&#46;"
            "apellidos" => "Janeiro"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "D&#237;az"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Homez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          9 => array:4 [
            "nombre" => "F&#46;"
            "apellidos" => "Gordo"
            "email" => array:1 [
              0 => "fgordo5&#64;gmail&#46;com"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          10 => array:3 [
            "nombre" => "I&#46;"
            "apellidos" => "Salinas"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Servicio de Medicina Intensiva&#44; Hospital Universitario del Henares&#44; Coslada&#44; Madrid&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Grado de Medicina&#44; Universidad Francisco de Vitoria&#44; Pozuelo de Alarc&#243;n&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Efecto sobre la mortalidad de la ampliaci&#243;n a los festivos y fines de semana del proyecto &#171;UCI sin paredes&#187;&#46; Estudio <span class="elsevierStyleItalic">before&#8211;after</span>"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1364
            "Ancho" => 1502
            "Tamanyo" => 69598
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Histogram showing the distribution of admissions according to work shift &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#46; Percentages&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Patient prognosis&#44; particularly in the case of critically ill individuals&#44; may be influenced by changes in care models occurring during the on-hour and off-hour periods&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">1&#8211;4</span></a> In our setting&#44; and although survival in all the periods was greater than predicted by the severity indicators&#44; admission to the Intensive Care Unit &#40;ICU&#41; during the off-hours period &#40;i&#46;e&#46;&#44; patients admitted in the course of the night shift of weekdays&#44; weekends and holidays &#91;WE-H&#93;&#41; was found to be independently associated to mortality when compared with the on-hours group &#40;patients admitted in the course of the morning and afternoon shifts of weekdays&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a> These findings are consistent with the published literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">1&#44;2</span></a> A special feature in our case has been the development of the &#8220;ICU without walls&#8221; project&#44; which is based on the early detection of patients at risk in hospital but outside the ICU&#44; and allows us to intervene early in conventional wards&#46; A before&#8211;after study published by our group showed this activity to offer benefit in terms of patient clinical outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">6</span></a> However&#44; the ICU without walls activity was limited to weekdays and was not carried out on WE-H&#46; In the multivariate analysis&#44; the variables independently associated to hospital mortality were found to be the SAPS 3 score and the fact of belonging to the WE-H subgroup&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">These results support the idea that the early detection of potentially seriously ill patients&#44; and their consequent improved survival&#44;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">6&#8211;10</span></a> could help explain the lesser mortality observed in the on-hours group&#44; where ICU without walls activity was applied&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The hypothesis of the present study is that extending the ICU without walls project to WE-H has an impact upon mortality among patients who are admitted during that time interval&#46; The primary objective was to determine whether extension to WE-H of the proactive early detection of severity in hospital and the intervention of intensivists in conventional wards and in the emergency room &#40;ICU without walls activity&#41; is associated to a decrease in mortality among patients admitted to the ICU on those days&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Patients and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">A quasi-experimental before&#8211;after study was conducted in an adult polyvalent medical-surgical ICU with 8 beds belonging to a second-level hospital with 210 beds&#46; An agreement was reached with hospital management to extend the early detection of severity system to WE-H&#46; This did not really imply any change in the personnel present on WE-H in our center&#59; accordingly&#44; we maintained an intensivist on duty and a second intensivist during 8<span class="elsevierStyleHsp" style=""></span>h in the morning shift&#8211;with addition of the ICU without walls activity during the intervention period&#46; A description of the working protocol can be found in the study published by Abella et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0025" class="elsevierStylePara elsevierViewall">In the control group &#40;analyzed in the previous study&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a> ICU without walls activity was not carried out&#44; and inclusion was made of the patients admitted to the ICU on WE-H from 1 January 2010 to 30 April 2013&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0030" class="elsevierStylePara elsevierViewall">In the intervention group&#44; ICU without walls activity was extended to WE-H&#44; and inclusion was made of the patients admitted to the ICU on WE-H from 1 May 2013 to 31 October 2014&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Patients admitted following scheduled surgery were excluded&#46;</p></li></ul></p><p id="par0040" class="elsevierStylePara elsevierViewall">An analysis was made of the patient demographic variables &#40;age&#44; sex&#41;&#44; origin &#40;emergency care&#44; hospital ward&#44; operating room&#41;&#44; type of patient &#40;medical&#44; surgical&#41;&#44; reason for admission&#44; comorbidities &#40;defined as comorbidity reflected in the case history&#44; with the present or past administration of treatment for that chronic disease&#41;&#44; the SAPS 3 as severity score upon admission&#44; organ failure during admission to the ICU based on the SOFA score&#44; stay in the ICU and in hospital&#44; and mortality in the ICU and in hospital&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">An analysis was also made of the changes in percentage admissions in the course of the morning&#44; afternoon and night shifts&#44; in order to evaluate the effect of extending the ICU without walls activity to WE-H upon the time of patient admission&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The study was approved by the local Ethics Committee&#46; A retrospective analysis of the results was made after implementing the change in management model&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Continuous variables were reported as the mean or median &#40;percentiles&#41;&#44; depending on the type of distribution&#46; The Kolmogorov-Smirnov test was used to assess normality of distribution of the continuous variables&#44; and comparisons were made using the nonparametric Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span>-test &#40;for variables with a non-normal distribution&#41; or the Student <span class="elsevierStyleItalic">t</span>-test &#40;for variables with a normal distribution&#41;&#46; Categorical variables were compared using the chi-squared test&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">A stepwise multivariate logistic regression analysis was made to explore correlations to mortality in the ICU and assess the possible effect of the intervention group upon outcome&#44; entering all the variables that clinically might be related to survival &#40;sex&#44; age&#44; type of patient&#44; origin&#44; comorbidities and SAPS 3 score&#41;&#46; Statistical significance was considered for <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 in all cases&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">The control group comprised 389 patients&#44; while 161 patients were included in the intervention group&#46; There were no differences between the groups in terms of age&#44; sex&#44; origin&#44; type of patient&#44; reason for admission&#44; or organ failure during admission to the ICU &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Although most of the comorbidities were comparable&#44; there was a statistically significant difference in terms of cardiovascular morbidity &#40;present in 49&#37; of the cases in the control group versus in 33&#37; of the cases in the intervention group&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Significant differences were also observed in terms of severity upon admission as assessed by the SAPS 3 scale&#44; with a median score of 52 &#40;percentiles 25&#8211;75&#58; 42&#8211;63&#41; in the control group versus 48 &#40;percentiles 25&#8211;75&#58; 40&#8211;56&#41; in the intervention group &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;008&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The predicted in-hospital mortality in both groups was 24&#37; and 19&#37;&#44; respectively&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The mean stay in the ICU and in hospital after discharge from the ICU showed no differences between the two groups&#44; with a median stay of three days &#40;percentiles 25&#8211;75&#58; 2&#8211;4&#41; in the ICU in the control group &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;15&#41; versus three days &#40;percentiles 25&#8211;75&#58; 2&#8211;4&#41; in the intervention group&#44; and with a median stay of four days &#40;percentiles 25&#8211;75&#58; 1&#8211;9&#41; after discharge from the ICU in the control group versus 5 days &#40;percentiles 25&#8211;75&#58; 1&#8211;9&#41; in the intervention group &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;67&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The mortality rate in the ICU was 11&#37; in the control group &#40;95&#37; confidence interval &#91;95&#37;CI&#93; 8&#8211;14&#41; versus 3&#37; in the intervention group &#40;95&#37;CI 1&#8211;7&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#44; with an absolute risk reduction of 8&#37; &#40;95&#37;CI 3&#8211;12&#41;&#46; The difference referred to in-hospital mortality was also statistically significant&#44; with 14&#37; &#40;95&#37;CI 11&#8211;18&#41; in the control group versus 6&#37; &#40;95&#37;CI 3&#8211;11&#41; in the intervention group &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;013&#41;&#44; with an absolute risk reduction of 8&#37; &#40;95&#37;CI 2&#8211;12&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Variations were observed in the percentage of admissions in the course of the morning&#44; afternoon and night shifts between the two groups&#46; In this regard&#44; an increase in the percentage of admissions was recorded in the morning and afternoon shifts&#44; with a decrease in the night shift&#44; in the intervention group &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">In the multivariate analysis&#44; the only two factors associated to mortality in the ICU were the SAPS 3 score &#40;odds ratio &#91;OR&#93; 1&#46;08&#59; 95&#37;CI 1&#46;06&#8211;1&#46;11&#41; and the fact of belonging to the intervention group &#40;OR 0&#46;33&#59; 95&#37;CI 0&#46;12&#8211;0&#46;89&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">In the present study&#44; although patient survival was greater than predicted by the severity indicators employed&#44; those subjects in the intervention group who were admitted to the ICU on WE-H&#44; following extension of the ICU without walls activity to those days&#44; were seen to have a better prognosis than the patients in the control group admitted to the ICU on WE-H in the absence of ICU without walls activity on those days&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The ICU without walls protocol has been designed for the early detection of patients at risk in the hospital&#44; outside the ICU&#44; and allows us to intervene before the patient suffers organ failure&#46; Such anticipation has been evaluated in different studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">7&#8211;13</span></a> fundamentally based on the fact that life-threatening situations are usually preceded by detectable and preventable physiopathological alterations&#46; This is particularly notorious in the case of time-dependent illnesses such as for example sepsis&#44; acute coronary syndrome or cardiac arrest&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">14&#8211;17</span></a> Specific alarm systems are being developed that combine clinical and laboratory test data&#44; and which offer decision algorithms for initial intervention and the need to inform the ICU&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">18&#8211;21</span></a> The worldwide initiative represented by the Surviving Sepsis Campaign has improved adherence to the clinical practice guides&#44; and has resulted in benefits for patients of this kind&#44; with a shortening of hospital stay and even reductions in mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">22&#8211;24</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">This concept of early action has become so important that the recommendations of the European Resuscitation Council for the management of cardiac arrest include as first link in the &#8220;chain of survival&#8221; the adoption of measures destined to prevent cardiac arrest through the detection of previously manifesting physiopathological alterations&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">25</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The recent systematic review published by Winters et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">26</span></a> reveals that many hospitals have developed rapid response teams with the aim of ensuring early detection and rapid response to situations of clinical worsening in patients admitted to conventional wards&#46; Furthermore&#44; different studies have demonstrated a decrease in cardiac arrest and also in mortality as a result of the introduction of such teams&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">This is the case of the study published by Schmidt et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">13</span></a> which described a time relationship between the introduction of a physiological signs monitoring system and diminished mortality in one hospital &#40;from 7&#46;75&#37; to 6&#46;42&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; with an estimated 397 fewer deaths&#44; while in another center the reduction in mortality was from 7&#46;57&#37; to 6&#46;15&#37; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; with an estimated 372 fewer deaths&#8211;these results being a consequence of greater reliability in the recording of vital signs and rapidity in decision making&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In the before&#8211;after study published by our group&#44; ICU without walls activity resulted in clinical outcome benefits&#44; improved management of the available healthcare resources&#44; and a decrease in mortality among the patients admitted to the ICU during the project implantation period &#40;OR 0&#46;42&#59; 95&#37;CI 0&#46;18&#8211;0&#46;98&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;04&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">6</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">On the other hand&#44; several studies analyzing differences in patient prognosis according to the time of admission to the ICU and even to other hospital areas have reported poorer survival on weekends<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">1&#8211;4&#44;27&#8211;29</span></a> &#8211; though other authors have obtained contradictory results&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">30&#8211;33</span></a> For this reason&#44; we decided to investigate whether there are differences in mortality in our concrete setting according to the time of day of admission to the ICU&#46; In this regard&#44; we distinguished between an on-hours group &#40;i&#46;e&#46;&#44; patients admitted in the course of the morning or afternoon shifts on weekdays&#41; and an off-hours group &#40;patients admitted in the course of the night shift&#44; WE-H&#41;&#44; and found admission to the off-hours group to be independently associated to mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">5</span></a> At that point we raised the hypothesis that ICU without walls activity could have a causal relation to increased survival on weekdays&#44; and conducted a subgroup analysis contrasting weekdays versus WE-H where no ICU without walls activity was carried out&#46; We found admission on WE-H to be independently associated to mortality&#46; However&#44; the non-interventional nature of the study did not allow us to demonstrate this hypothesis&#44; and we were only able to support a possible relationship between ICU without walls activity and differences in mortality&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In the present study we compared the prognosis of patients admitted to intensive care in a group lacking ICU without walls activity on WE-H versus another group in which ICU without walls activity was carried out&#46; The groups were comparable except for cardiovascular comorbidity and severity at the time of admission &#40;both being greater in the control group&#41;&#46; This could be explained in terms of the purpose of ICU without walls activity&#44; which seeks early identification and management of patients at risk&#44; i&#46;e&#46;&#44; intervention is targeted to less critically ill subjects&#46; In addition to the difference in mortality in the univariate analysis&#44; the logistic regression model found the only two factors associated to mortality in the ICU to be the SAPS 3 score &#40;OR 1&#46;08&#59; 95&#37;CI 1&#46;06&#8211;1&#46;11&#41; and the fact of belonging to the intervention group &#40;OR 0&#46;33&#59; 95&#37;CI 0&#46;12&#8211;0&#46;89&#41;&#46; On the other hand&#44; a change was noted in the distribution of admissions according to work shift&#8211;with an increase in the percentage of admissions during the morning and afternoon shifts&#8211;thereby facilitating better healthcare resource utilization&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">As limitations of our study&#44; mention must be made of its single-center nature and the fact that we used the SAPS 3 as a severity indicator at the time of admission to the ICU&#46; In this respect&#44; in populations with a low incidence of organic failure&#44; this scale overestimates predicted mortality&#44; and this could explain the important difference between predicted and real in-hospital mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">34</span></a> The study period in both groups was moreover different&#44; and this could have resulted in minor bias due to greater seasonal mortality and lesser ICU occupation during the summer months&#46; However&#44; there were no differences in mortality in the control group in any of the periods&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">What we have found in these studies is that the favorable results are attributable to&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">1&#46;</span><p id="par0145" class="elsevierStylePara elsevierViewall">Earlier admission to the ICU of certain patients at risk&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">2&#46;</span><p id="par0150" class="elsevierStylePara elsevierViewall">Improved patient selection &#40;screening&#41; on deciding admission&#8211;some patients being amenable to management in conventional wards without having to occupy an ICU bed&#44; thereby contributing to improve the availability of beds in the Unit&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">3&#46;</span><p id="par0155" class="elsevierStylePara elsevierViewall">The implementation of plans referred to patient care and limitation of life support measures in the ward&#44; with consensus-based decision making&#44; in order to avoid unnecessary admissions to the ICU&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">4&#46;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Reduction of in-hospital cardiac arrest&#46;</p></li></ul></p><p id="par0165" class="elsevierStylePara elsevierViewall">It was not our intention in this study to analyze the underlying causes &#40;undoubtedly of great interest&#41;&#44; but only to evaluate the effect of the organizational change made&#46; In order to analyze these factors &#40;as has been done in earlier studies&#41;&#44; a larger sample size and the conduction of possibly multicenter trials would be needed&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Extension of ICU without walls activity to WE-H results in a decrease in patient mortality both in the ICU and in hospital&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:10 [
        0 => array:3 [
          "identificador" => "xres678037"
          "titulo" => "Abstract"
          "secciones" => array:7 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objective"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Design"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Setting"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Patients or participants"
            ]
            4 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Variables of interest"
            ]
            5 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Results"
            ]
            6 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec684009"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres678038"
          "titulo" => "Resumen"
          "secciones" => array:7 [
            0 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0045"
              "titulo" => "Dise&#241;o"
            ]
            2 => array:2 [
              "identificador" => "abst0050"
              "titulo" => "&#193;mbito"
            ]
            3 => array:2 [
              "identificador" => "abst0055"
              "titulo" => "Pacientes o participantes"
            ]
            4 => array:2 [
              "identificador" => "abst0060"
              "titulo" => "Variables de inter&#233;s"
            ]
            5 => array:2 [
              "identificador" => "abst0065"
              "titulo" => "Resultados"
            ]
            6 => array:2 [
              "identificador" => "abst0070"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec684008"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Patients and methods"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflicts of interest"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2015-05-19"
    "fechaAceptado" => "2015-09-01"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec684009"
          "palabras" => array:6 [
            0 => "Early diagnosis"
            1 => "Decision support techniques"
            2 => "Hospital rapid response team"
            3 => "Outcome"
            4 => "Critical care"
            5 => "Time admission"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec684008"
          "palabras" => array:6 [
            0 => "Diagn&#243;stico precoz"
            1 => "Herramientas de decisi&#243;n cl&#237;nica"
            2 => "Equipos de respuesta r&#225;pida"
            3 => "Pron&#243;stico"
            4 => "Cuidados cr&#237;ticos"
            5 => "Momento de ingreso"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine whether extension to holidays and weekends of the protocol for the early proactive detection of severity in hospital &#40;&#8220;ICU without walls&#8221; project&#41; results in decreased mortality among patients admitted to the ICU during those days&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A quasi-experimental before&#8211;after study was carried out&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Setting</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A level 2 hospital with 210 beds and a polyvalent ICU with 8 beds&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Patients or participants</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The control group involved no &#8220;ICU without walls&#8221; activity on holidays or weekends and included those patients admitted to the ICU on those days between 1 January 2010 and 30 April 2013&#46; The intervention group in turn extended the &#8220;ICU without walls&#8221; activity to holidays and weekends&#44; and included those patients admitted on those days between 1 May 2013 and 31 October 2014&#46; Patients arriving from the operating room after scheduled surgery were excluded&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Variables of interest</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">An analysis was made of the demographic variables &#40;age&#44; gender&#41;&#44; origin &#40;emergency room&#44; hospital ward&#44; operating room&#41;&#44; type of patient &#40;medical&#44; surgical&#41;&#44; reason for admission&#44; comorbidities and SAPS 3 score as a measure of severity upon admission&#44; stay in the ICU and in hospital&#44; and mortality in the ICU and in hospital&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A total of 389 and 161 patients were included in the control group and intervention group&#44; respectively&#46; There were no differences between the 2 groups except as regards cardiovascular comorbidity &#40;49&#37; in the control group versus 33&#37; in the intervention group&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; severity upon admission &#40;median SAPS 3 score 52 &#91;percentiles 25&#8211;75&#58; 42&#8211;63&#41; in the control group versus 48 &#91;percentiles 25&#8211;75&#58; 40&#8211;56&#93; in the intervention group&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;008&#41; and mortality in the ICU &#40;11&#37; in the control group &#91;95&#37; CI 8&#8211;14&#93; versus 3&#37; &#91;95&#37; CI 1&#8211;7&#93; in the intervention group&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;003&#41;&#46; In the multivariate analysis&#44; the only 2 factors associated to mortality in the ICU were the SAPS 3 score &#40;OR 1&#46;08&#59; 95&#37; CI 1&#46;06&#8211;1&#46;11&#41; and inclusion in the intervention group &#40;OR 0&#46;33&#59; 95&#37; CI 0&#46;12&#8211;0&#46;89&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusions</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Extension of the &#8220;ICU without walls&#8221; activity to holidays and weekends results in a decrease in mortality in the ICU&#46;</p></span>"
        "secciones" => array:7 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Design"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Setting"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Patients or participants"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Variables of interest"
          ]
          5 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Results"
          ]
          6 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudiar si la ampliaci&#243;n&#44; a festivos y fines de semana&#44; del protocolo de detecci&#243;n proactiva precoz de gravedad en el hospital y actuaci&#243;n de intensivistas en planta convencional y urgencias &#40;actividad &#171;UCI sin paredes&#187;&#41; se asocia a una reducci&#243;n en la mortalidad de los pacientes ingresados en UCI en esos d&#237;as&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Dise&#241;o</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Estudio cuasiexperimental <span class="elsevierStyleItalic">before&#8211;after&#46;</span></p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">&#193;mbito</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Hospital de nivel 2 con 210 camas en funcionamiento y UCI polivalente con 8 camas&#46;</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Pacientes o participantes</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">En el grupo control&#44; donde no se realiza la actividad &#171;UCI sin paredes&#187; los fines de semana ni festivos&#44; se incluyeron los pacientes ingresados en la UCI esos d&#237;as del 1 de enero de 2010 al 30 de abril de 2013&#46; En el grupo intervenci&#243;n se ampli&#243; la actividad &#171;UCI sin paredes&#187; a los fines de semana y festivos y se incluyeron los pacientes ingresados esos d&#237;as del 1 de mayo de 2013 al 31 de octubre de 2014&#46; Se excluyeron los pacientes procedentes de quir&#243;fano tras una cirug&#237;a programada&#46;</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Variables de inter&#233;s</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se analizaron las variables demogr&#225;ficas &#40;edad&#44; sexo&#41;&#44; la procedencia &#40;urgencias&#44; planta de hospitalizaci&#243;n&#44; quir&#243;fano&#41;&#44; el tipo de paciente &#40;m&#233;dico&#44; quir&#250;rgico&#41;&#44; el motivo de ingreso&#44; las comorbilidades y el SAPS 3 como puntuaci&#243;n de gravedad al ingreso&#44; estancia en UCI y hospitalaria&#44; adem&#225;s de la mortalidad en la UCI y en el hospital&#46;</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron en el grupo control 389 pacientes&#44; y 161 en el grupo intervenci&#243;n&#46; No se encontraron diferencias entre ambos grupos&#44; salvo en la comorbilidad cardiovascular &#40;un 49&#37; en el grupo control frente a un 33&#37; en el grupo intervenci&#243;n&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; en la gravedad al ingreso medida mediante el SAPS 3 &#40;mediana de 52 &#91;percentiles 25&#8211;75&#58; 42&#8211;63&#93; en el grupo control frente a 48 &#91;percentiles 25&#8211;75&#58; 40&#8211;56&#93; en el grupo intervenci&#243;n&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;008&#41; y en la mortalidad en UCI&#44; que fue de un 11&#37; en el grupo control &#40;IC 95&#37; 8 a 14&#41; frente al 3&#37; &#40;IC 95&#37; 1 a 7&#41; en el grupo intervenci&#243;n &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;003&#41;&#46; En el an&#225;lisis multivariable&#44; los 2 &#250;nicos factores asociados con la mortalidad en UCI fueron&#58; SAPS 3 &#40;OR 1&#44;08&#59; IC 95&#37; 1&#44;06&#8211;1&#44;11&#41; y el pertenecer al grupo intervenci&#243;n &#40;OR 0&#44;33&#59; IC 95&#37; 0&#44;12&#8211;0&#44;89&#41;&#46;</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusiones</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La ampliaci&#243;n de la actividad &#171;UCI sin paredes&#187; a los fines de semana y festivos conlleva un descenso en la mortalidad en la UCI&#46;</p></span>"
        "secciones" => array:7 [
          0 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Dise&#241;o"
          ]
          2 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "&#193;mbito"
          ]
          3 => array:2 [
            "identificador" => "abst0055"
            "titulo" => "Pacientes o participantes"
          ]
          4 => array:2 [
            "identificador" => "abst0060"
            "titulo" => "Variables de inter&#233;s"
          ]
          5 => array:2 [
            "identificador" => "abst0065"
            "titulo" => "Resultados"
          ]
          6 => array:2 [
            "identificador" => "abst0070"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Abella A&#44; Enciso V&#44; Torrej&#243;n I&#44; Hermosa C&#44; Mozo T&#44; Molina R&#44; et al&#46; Efecto sobre la mortalidad de la ampliaci&#243;n a los festivos y fines de semana del proyecto &#171;UCI sin paredes&#187;&#46; Estudio <span class="elsevierStyleItalic">before&#8211;after</span>&#46; Med Intensiva&#46; 2016&#59;40&#58;273&#8211;279&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1364
            "Ancho" => 1502
            "Tamanyo" => 69598
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Histogram showing the distribution of admissions according to work shift &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#46; Percentages&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">SAPS 3&#58; simplified acute physiology score&#59; SOFA&#58; sequential organ failure assessment&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control group &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>389&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Intervention group &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>161&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age in years&#44; median &#40;percentiles 25&#8211;75&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64 &#40;52&#8211;76&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64 &#40;53&#8211;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sex&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Males&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">236 &#40;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">101 &#40;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Females&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">153 &#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60 &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Origin&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Emergency room&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">283 &#40;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">113 &#40;70&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ward&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Operating room&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">57 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Type of patient&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Medical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">323 &#40;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">125 &#40;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Surgical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Reason for admission&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sepsis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">59 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ischemic heart disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">106 &#40;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiac arrest&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other medical reason&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">168 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Postoperative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47 &#40;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Comorbidities&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiovascular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">189 &#40;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Respiratory&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">84 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Renal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hepatic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Oncological&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">51 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Endocrine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">107 &#40;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="char" valign="top"><span class="elsevierStyleItalic">Organ failure developing during stay &#40;SOFA scale&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiovascular failure&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">159 &#40;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Respiratory failure&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">184 &#40;47&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Renal failure&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">99 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>SAPS 3&#44; median &#40;percentiles 25&#8211;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">52 &#40;42&#8211;63&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;40&#8211;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1112742.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Demographic variables of the two groups&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:34 [
            0 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Increased mortality associated with after-hours and weekend admission to the intensive care unit&#58; a retrospective analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46; Bhonagiri"
                            1 => "D&#46;V&#46; Pilcher"
                            2 => "M&#46;J&#46; Bailey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med J Aust"
                        "fecha" => "2011"
                        "volumen" => "194"
                        "paginaInicial" => "287"
                        "paginaFinal" => "292"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21426282"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hospital mortality is associated with ICU admission time"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46;A&#46; Kuijsten"
                            1 => "S&#46; Brinkman"
                            2 => "I&#46;A&#46; Meynaar"
                            3 => "P&#46;E&#46; Spronk"
                            4 => "J&#46;I&#46; van der Spoel"
                            5 => "R&#46;J&#46; Bosman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-010-1918-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2010"
                        "volumen" => "36"
                        "paginaInicial" => "1765"
                        "paginaFinal" => "1771"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20549184"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Weekend hospitalization and additional risk of death&#58; an analysis of inpatient data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Freemantle"
                            1 => "M&#46; Richardson"
                            2 => "J&#46; Wood"
                            3 => "D&#46; Ray"
                            4 => "S&#46; Khosla"
                            5 => "D&#46; Shahian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1258/jrsm.2012.120009"
                      "Revista" => array:6 [
                        "tituloSerie" => "J R Soc Med"
                        "fecha" => "2012"
                        "volumen" => "105"
                        "paginaInicial" => "74"
                        "paginaFinal" => "84"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22307037"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of &#8220;never events&#8221; among weekend admissions versus week day admissions to US hospitals&#58; national analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;J&#46; Attenello"
                            1 => "T&#46; Wen"
                            2 => "S&#46;Y&#46; Cen"
                            3 => "A&#46; Ng"
                            4 => "M&#46; Kim-Tenser"
                            5 => "N&#46; Sanossian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.h1460"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2015"
                        "volumen" => "350"
                        "paginaInicial" => "h1460"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25876878"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efecto del momento de ingreso sobre el pron&#243;stico de los pacientes en la Unidad de Cuidados Intensivos&#58; <span class="elsevierStyleItalic">on-hours</span> vs <span class="elsevierStyleItalic">off-hours</span>"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Abella"
                            1 => "C&#46; Hermosa"
                            2 => "V&#46; Enciso"
                            3 => "I&#46; Torrej&#243;n"
                            4 => "R&#46; Molina"
                            5 => "I&#46; Salinas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2014.11.009"
                      "Revista" => array:3 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2015"
                        "itemHostRev" => array:3 [
                          "pii" => "S0264410X12016301"
                          "estado" => "S300"
                          "issn" => "0264410X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ICU without walls project&#46; Effect of the early detection of patients at risk"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Abella &#193;lvarez"
                            1 => "I&#46; Torrejo¿n P&#233;rez"
                            2 => "V&#46; Enciso Calder&#243;n"
                            3 => "C&#46; Hermosa Gelbard"
                            4 => "J&#46;J&#46; Sicilia Urban"
                            5 => "M&#46; Ruiz Grinspan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2012.08.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2013"
                        "volumen" => "37"
                        "paginaInicial" => "12"
                        "paginaFinal" => "18"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23059055"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multicenter development and validation of a risk stratification tool for ward patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;M&#46; Churpek"
                            1 => "T&#46;C&#46; Yuen"
                            2 => "C&#46; Winslow"
                            3 => "A&#46;A&#46; Robicsek"
                            4 => "D&#46;O&#46; Meltzer"
                            5 => "R&#46;D&#46; Gibbons"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201406-1022OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2014"
                        "volumen" => "190"
                        "paginaInicial" => "649"
                        "paginaFinal" => "655"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25089847"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "SECI &#40;Servicio Extendido de Cuidados Intensivos&#41;&#58; mirando fuera de la UCI"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;S&#46; Holanda Pe&#241;a"
                            1 => "M&#46;J&#46; Dom&#237;nguez Artiga"
                            2 => "E&#46; Ots Ruiz"
                            3 => "M&#46;I&#46; Lorda de los Ri¿os"
                            4 => "A&#46; Castellanos Ortega"
                            5 => "F&#46; Ortiz Mel&#243;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2011.03.012"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2011"
                        "volumen" => "35"
                        "paginaInicial" => "349"
                        "paginaFinal" => "353"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21571395"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aplicaci&#243;n de las t&#233;cnicas de informaci&#243;n y comunicaci&#243;n para la detecci&#243;n de pacientes de alto riesgo&#58; alarmas de r&#225;pida asistencia&#46; Estudio piloto del proyecto ARA-Son Ll&#224;tzer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L&#46; Soci¿as Crespi¿"
                            1 => "G&#46; Heras la Calle"
                            2 => "V&#46;M&#46; Estrada Rodri¿guez"
                            3 => "A&#46; Garc&#237;a S&#225;nchez"
                            4 => "P&#46; Ib&#225;&#241;ez-Luci¿a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2012.04.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2013"
                        "volumen" => "37"
                        "paginaInicial" => "19"
                        "paginaFinal" => "26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22683046"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impacto de un nuevo modelo de Medicina Intensiva sobre la asistencia en un servicio de Medicina Intensiva"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Gonz&#225;lez Castro"
                            1 => "F&#46; Ortiz Mel&#243;n"
                            2 => "B&#46; Suberviola"
                            3 => "M&#46;S&#46; Holanda Pe&#241;a"
                            4 => "M&#46;J&#46; Dom&#237;nguez"
                            5 => "C&#46; Blanco Huelga"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2012.06.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2013"
                        "volumen" => "37"
                        "paginaInicial" => "27"
                        "paginaFinal" => "32"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22959859"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rapid response teams&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46;S&#46; Chan"
                            1 => "R&#46; Jain"
                            2 => "B&#46;K&#46; Nallmothu"
                            3 => "R&#46;A&#46; Berg"
                            4 => "C&#46; Sasson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Adv Intern Med"
                        "fecha" => "2010"
                        "volumen" => "170"
                        "paginaInicial" => "18"
                        "paginaFinal" => "26"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rapid response team-triggered procalcitonin measurement predicts infectious intensive care unit transfers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;G&#46; Wunderink"
                            1 => "E&#46;R&#46; Diederich"
                            2 => "M&#46;P&#46; Caramez"
                            3 => "H&#46;K&#46; Donnelly"
                            4 => "S&#46;D&#46; Norwood"
                            5 => "A&#46; Kho"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e31824fc027"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2012"
                        "volumen" => "40"
                        "paginaInicial" => "2090"
                        "paginaFinal" => "2095"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22564964"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of introducing an electronic physiological surveillance system on hospital mortality"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;E&#46; Schmidt"
                            1 => "P&#46; Meredith"
                            2 => "D&#46;R&#46; Prytherch"
                            3 => "D&#46; Watson"
                            4 => "V&#46; Watson"
                            5 => "R&#46;M&#46; Killen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmjqs-2014-003073"
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ Qual Saf"
                        "fecha" => "2015"
                        "volumen" => "24"
                        "paginaInicial" => "10"
                        "paginaFinal" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25249636"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical antecedents to in-hospital cardiopulmonary arrest"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46; Schein"
                            1 => "N&#46; Hazday"
                            2 => "M&#46; Pena"
                            3 => "B&#46;H&#46; Ruben"
                            4 => "C&#46;L&#46; Sprung"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "1990"
                        "volumen" => "98"
                        "paginaInicial" => "1388"
                        "paginaFinal" => "1392"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2245680"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Physiological values and procedures in the 24<span class="elsevierStyleHsp" style=""></span>h before ICU admission from the ward"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;R&#46; Goldhill"
                            1 => "S&#46;A&#46; White"
                            2 => "A&#46; Sumner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Anaesthesia"
                        "fecha" => "1999"
                        "volumen" => "54"
                        "paginaInicial" => "529"
                        "paginaFinal" => "534"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10403864"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Duration of life-threatening antecedents prior to intensive care admission"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;M&#46; Hillman"
                            1 => "P&#46;J&#46; Bristow"
                            2 => "T&#46; Chey"
                            3 => "K&#46; Daffurn"
                            4 => "T&#46; Jacques"
                            5 => "S&#46;L&#46; Norman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-002-1496-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2002"
                        "volumen" => "28"
                        "paginaInicial" => "1629"
                        "paginaFinal" => "1634"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12415452"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A comparison of antecedents to cardiac arrests&#44; deaths and emergency intensive care admissions in Australia and New Zealand&#44; and in the United Kingdom &#8211; The ACADEMIA study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Kause"
                            1 => "G&#46; Smith"
                            2 => "D&#46; Prytherch"
                            3 => "M&#46; Parr"
                            4 => "A&#46; Flabouris"
                            5 => "K&#46; Hillman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.resuscitation.2004.05.016"
                      "Revista" => array:6 [
                        "tituloSerie" => "Resuscitation"
                        "fecha" => "2004"
                        "volumen" => "62"
                        "paginaInicial" => "275"
                        "paginaFinal" => "282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15325446"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gu&#237;as de Pr&#225;ctica Cl&#237;nica de la Sociedad Europea de Cardiolog&#237;a &#40;ESC&#41;&#46; Manejo del infarto agudo de miocardio en pacientes con elevaci&#243;n persistente del segmento ST"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Van der Werf"
                            1 => "J&#46; Bax"
                            2 => "A&#46; Betriu"
                            3 => "C&#46; Blomstrom-Lundqvist"
                            4 => "F&#46; Crea"
                            5 => "V&#46; Falk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0300-8932(09)70373-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2009"
                        "volumen" => "62"
                        "paginaInicial" => "e1"
                        "paginaFinal" => "e47"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23040488"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical practice guideline&#58; endpoints of resuscitation in trauma patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Tisherman"
                            1 => "P&#46; Barie"
                            2 => "F&#46; Bokhari"
                            3 => "J&#46; Bonadies"
                            4 => "B&#46; Daley"
                            5 => "L&#46; Diebel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma"
                        "fecha" => "2004"
                        "volumen" => "57"
                        "paginaInicial" => "898"
                        "paginaFinal" => "912"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15514553"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the early management of patients with acute ischemic stroke&#58; a guideline for healthcare professionals from the American Heart Association&#47;American Stroke Association"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;C&#46; Jauch"
                            1 => "J&#46;L&#46; Saver"
                            2 => "H&#46;P&#46; Adams Jr&#46;"
                            3 => "A&#46; Bruno"
                            4 => "J&#46;J&#46; Connors"
                            5 => "B&#46;M&#46; Demaerschalk"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/STR.0b013e318284056a"
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2013"
                        "volumen" => "44"
                        "paginaInicial" => "870"
                        "paginaFinal" => "947"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23370205"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surviving sepsis campaign&#58; international guidelines for management of severe sepsis and septic shock&#44; 2012"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46;P&#46; Dellinger"
                            1 => "M&#46;M&#46; Levy"
                            2 => "A&#46; Rhodes"
                            3 => "D&#46; Annane"
                            4 => "H&#46; Gerlach"
                            5 => "S&#46;M&#46; Opal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-012-2769-8"
                      "Revista" => array:7 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2013"
                        "volumen" => "39"
                        "paginaInicial" => "165"
                        "paginaFinal" => "228"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23361625"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0264410X14009359"
                          "estado" => "S300"
                          "issn" => "0264410X"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness of treatments for severe sepsis&#58; a prospective&#44; multicenter&#44; observational study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Ferrer"
                            1 => "A&#46; Artigas"
                            2 => "D&#46; Suarez"
                            3 => "E&#46; Palencia"
                            4 => "M&#46;M&#46; Levy"
                            5 => "A&#46; Arenzana"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200812-1912OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2009"
                        "volumen" => "180"
                        "paginaInicial" => "861"
                        "paginaFinal" => "866"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19696442"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Improvement in process of care and outcome after a multicenter severe sepsis educational program in Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Ferrer"
                            1 => "A&#46; Artigas"
                            2 => "M&#46;M&#46; Levy"
                            3 => "J&#46; Blanco"
                            4 => "G&#46; Gonz&#225;lez-D&#237;az"
                            5 => "J&#46; Garnacho-Montero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jama.299.19.2294"
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA"
                        "fecha" => "2008"
                        "volumen" => "299"
                        "paginaInicial" => "2294"
                        "paginaFinal" => "2303"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18492971"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of the Surviving Sepsis Campaign protocols on hospital length of stay and mortality in septic shock patients&#58; results of a three-year follow-up quasi-experimental study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Castellanos Ortega"
                            1 => "B&#46; Suberviola"
                            2 => "L&#46; Garc&#237;a Astudillo"
                            3 => "M&#46;S&#46; Holanda"
                            4 => "F&#46; Ortiz"
                            5 => "J&#46; Llorca"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/CCM.0b013e3181d455b6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Crit Care Med"
                        "fecha" => "2010"
                        "volumen" => "38"
                        "paginaInicial" => "1036"
                        "paginaFinal" => "1043"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20154597"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European Resuscitation Council Guidelines for Resuscitation 2010 Section 1&#46; Executive summary"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;P&#46; Nolan"
                            1 => "J&#46; Soar"
                            2 => "D&#46;A&#46; Zideman"
                            3 => "D&#46; Biarent"
                            4 => "L&#46;L&#46; Bossaert"
                            5 => "C&#46; Deakin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.resuscitation.2010.08.021"
                      "Revista" => array:6 [
                        "tituloSerie" => "Resuscitation"
                        "fecha" => "2010"
                        "volumen" => "81"
                        "paginaInicial" => "1219"
                        "paginaFinal" => "1276"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20956052"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rapid-response systems as a patient safety strategy&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;D&#46; Winters"
                            1 => "S&#46;J&#46; Weaver"
                            2 => "E&#46;R&#46; Pfoh"
                            3 => "T&#46; Yang"
                            4 => "J&#46;C&#46; Pham"
                            5 => "S&#46;M&#46; Dy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7326/0003-4819-158-5-201303051-00009"
                      "Revista" => array:7 [
                        "tituloSerie" => "Ann Intern Med"
                        "fecha" => "2013"
                        "volumen" => "158"
                        "numero" => "5 &#40;Pt 2&#41;"
                        "paginaInicial" => "417"
                        "paginaFinal" => "425"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23460099"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Off-hour presentation and outcomes in patients with acute myocardial infarction&#58; systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Sorita"
                            1 => "A&#46; Ahmed"
                            2 => "S&#46;R&#46; Starr"
                            3 => "K&#46;M&#46; Thompson"
                            4 => "D&#46;A&#46; Reed"
                            5 => "L&#46; Prokop"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2014"
                        "volumen" => "348"
                        "paginaInicial" => "f7393"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24452368"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Day of week of procedure and 30 day mortality for elective surgery&#58; retrospective analysis of hospital episode statistics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46; Aylin"
                            1 => "R&#46; Alexandrescu"
                            2 => "M&#46;H&#46; Jen"
                            3 => "E&#46;K&#46; Mayer"
                            4 => "A&#46; Bottle"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2013"
                        "volumen" => "346"
                        "paginaInicial" => "f2424"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23716356"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673615608224"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0315"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Weekend admission as an independent predictor of mortality&#58; an analysis of Scottish hospital admissions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;E&#46; Handel"
                            1 => "S&#46;V&#46; Patel"
                            2 => "A&#46; Skingsley"
                            3 => "K&#46; Bramley"
                            4 => "R&#46; Sobieski"
                            5 => "S&#46;V&#46; Ramagopalan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmjopen-2012-001789"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ Open"
                        "fecha" => "2012"
                        "volumen" => "2"
                        "paginaInicial" => "e001789"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23135542"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0320"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of admission time on mortality in an intensive care unit in Mainland China&#58; a propensity score matching analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;J&#46; Ju"
                            1 => "G&#46;W&#46; Tu"
                            2 => "Y&#46; Han"
                            3 => "H&#46;Y&#46; He"
                            4 => "Y&#46;Z&#46; He"
                            5 => "H&#46;L&#46; Mao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/cc13053"
                      "Revista" => array:5 [
                        "tituloSerie" => "Crit Care"
                        "fecha" => "2013"
                        "volumen" => "17"
                        "paginaInicial" => "R230"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24112558"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0325"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Weekend versus weekday hospital deaths&#58; analysis of in-patient data in a Nigerian tertiary healthcare center"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;O&#46; Nwosu"
                            1 => "N&#46;O&#46; Eke"
                            2 => "A&#46; Obi-Nwosu"
                            3 => "O&#46;J&#46; Osakwe"
                            4 => "C&#46;O&#46; Eke"
                            5 => "N&#46;P&#46; Obi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4103/1119-3077.116900"
                      "Revista" => array:6 [
                        "tituloSerie" => "Niger J Clin Pract"
                        "fecha" => "2013"
                        "volumen" => "16"
                        "paginaInicial" => "501"
                        "paginaFinal" => "504"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23974747"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0330"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mortality associated with timing of admission to and discharge from ICU&#58; a retrospective cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;B&#46; Laupland"
                            1 => "B&#46; Misset"
                            2 => "B&#46; Souweine"
                            3 => "A&#46; Tabah"
                            4 => "E&#46; Azoulay"
                            5 => "D&#46; Goldgran-Toledano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1472-6963-11-321"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Health Serv Res"
                        "fecha" => "2011"
                        "volumen" => "11"
                        "paginaInicial" => "321"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22115194"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0335"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association between time of admission to the ICU and mortality&#58; a systematic review and metaanalysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Cavallazzi"
                            1 => "P&#46;E&#46; Marik"
                            2 => "A&#46; Hirani"
                            3 => "M&#46; Pachinburavan"
                            4 => "T&#46;S&#46; Vasu"
                            5 => "B&#46;E&#46; Leiby"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.09-3018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2010"
                        "volumen" => "138"
                        "paginaInicial" => "68"
                        "paginaFinal" => "75"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20418364"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0340"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "External validation of the simplified acute physiology score &#40;SAPS&#41; 3 in Spain"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; L&#243;pez-Caler"
                            1 => "M&#46; Garci¿a-Delgado"
                            2 => "J&#46; Carpio-Sanz"
                            3 => "J&#46; Alvarez-Rodri¿guez"
                            4 => "E&#46; Aguilar-Alonso"
                            5 => "E&#46; Castillo-Lorente"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.medin.2013.06.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Intensiva"
                        "fecha" => "2014"
                        "volumen" => "38"
                        "paginaInicial" => "288"
                        "paginaFinal" => "296"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24053903"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735727/0000004000000005/v1_201606250031/S2173572716300182/v1_201606250031/en/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/21735727/0000004000000005/v1_201606250031/S2173572716300182/v1_201606250031/en/main.pdf?idApp=WMIE&text.app=https://medintensiva.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300182?idApp=WMIE"
]

Article information

ISSN: 21735727
Original language: English

DOI:10.1016/j.medine.2015.09.002

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	9	15	24
2024 October	50	40	90
2024 September	50	29	79
2024 August	51	47	98
2024 July	54	30	84
2024 June	49	32	81
2024 May	37	21	58
2024 April	51	45	96
2024 March	41	21	62
2024 February	42	38	80
2024 January	34	39	73
2023 December	39	35	74
2023 November	40	35	75
2023 October	26	27	53
2023 September	37	39	76
2023 August	53	18	71
2023 July	46	19	65
2023 June	33	17	50
2023 May	56	33	89
2023 April	27	19	46
2023 March	37	35	72
2023 February	34	32	66
2023 January	25	31	56
2022 December	64	28	92
2022 November	55	51	106
2022 October	71	31	102
2022 September	47	38	85
2022 August	36	31	67
2022 July	31	27	58
2022 June	29	25	54
2022 May	38	41	79
2022 April	42	36	78
2022 March	38	39	77
2022 February	34	23	57
2022 January	42	39	81
2021 December	50	49	99
2021 November	38	40	78
2021 October	62	59	121
2021 September	38	34	72
2021 August	39	33	72
2021 July	38	28	66
2021 June	35	22	57
2021 May	52	49	101
2021 April	172	86	258
2021 March	62	31	93
2021 February	45	26	71
2021 January	43	32	75
2020 December	44	21	65
2020 November	39	21	60
2020 October	44	29	73
2020 September	49	19	68
2020 August	31	20	51
2020 July	30	20	50
2020 June	32	19	51
2020 May	22	17	39
2020 April	38	14	52
2020 March	20	15	35
2020 February	36	36	72
2020 January	43	30	73
2019 December	44	21	65
2019 November	41	29	70
2019 October	54	23	77
2019 September	32	21	53
2019 August	42	21	63
2019 July	49	31	80
2019 June	31	18	49
2019 May	54	30	84
2019 April	43	16	59
2019 March	31	32	63
2019 February	43	26	69
2019 January	47	28	75
2018 December	108	33	141
2018 November	122	56	178
2018 October	102	30	132
2018 September	41	7	48
2018 August	43	13	56
2018 July	24	9	33
2018 June	27	12	39
2018 May	25	7	32
2018 April	21	5	26
2018 March	17	7	24
2018 February	14	7	21
2018 January	30	8	38
2017 December	20	1	21
2017 November	24	9	33
2017 October	33	4	37
2017 September	25	7	32
2017 August	22	11	33
2017 July	24	6	30
2017 June	25	18	43
2017 May	36	11	47
2017 April	27	24	51
2017 March	27	14	41
2017 February	13	15	28
2017 January	8	4	12
2016 December	16	25	41
2016 November	20	27	47
2016 October	35	0	35
2016 September	40	0	40
2016 August	1	1	2

Show all

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter