https://www.eurekalert.org/pub_relea...-ica021408.php

Late Nights and Weekends Are Bad Times for In-Hospital Cardiac Arrests
CHARLES BANKHEAD - MedPage Today

Source: Journal of the American Medical Association
Peberdy MA, et al "Survival from in-hospital cardiac arrest during nights and weekends"JAMA 2008; 299: 785-792.

Thanks to Larry Dossey, MD

RICHMOND, Va.-- Patients who have in-hospital cardiac arrests at night or on weekends are more likely to die than those who arrest at other times, according to data from a national registry.

Return of spontaneous circulation and favorable neurologic outcomes also were significantly lower in patients who had cardiac arrests at night versus day or evening hours (P0.001), Mary Ann Peberdy, M.D., of Virginia Commonwealth University, and colleagues reported in the Feb. 20 issue of the Journal of the American Medical Association.

Patients who had in-hospital arrests during day or evening hours had significantly lower survival if the arrests occurred on weekends versus weekdays.

"The mechanism for the decreased survival during the night is likely multifactorial, potentially including biological differences in patients as well as healthcare staff and hospital staffing and operational factors," the authors said. "These data suggest the need to focus on night and weekend hospital-wide resuscitation system processes of care that can potentially improve patient safety and survival following cardiac arrest."

The findings came from data provided by 507 hospitals in the National Registry of Cardiopulmonary Resuscitation, sponsored by the American Heart Association. Data for the study covered the period from Jan. 1, 2000 through Feb. 1, 2007.

The primary objective of the study was to characterize the frequency and survival of in-hospital cardiac arrest by time of day and day of week. Investigators defined day/evening as 7 a.m. to 10:59 p.m., night as 11 p.m. to 6:59 a.m., and weekend as 11 p.m. Friday to 6:59 a.m. Monday.

The analysis included 86,748 consecutive in-hospital cardiac arrests. The total comprised 58,593 arrests during day/evening hours (43,483 on weekdays and 15,110 on weekends) and 28,155 during evening hours (20,365 on weekdays and 7,790 on weekends).

Comparing outcomes for arrests that occurred during day/evening hours or at night, the investigators found that arrest at night was associated with significantly lower rates of:

* Survival to discharge (14.7% versus 19.8%).
* Return of spontaneous circulation for more than 20 minutes (44.7% versus 51.1%).
* Survival at 24 hours (28.9% versus 35.4%).
* Favorable neurologic outcomes (11% versus 15.5%).

Cardiac arrest at night also was significantly more often associated with asystole as the first documented rhythm and less often associated with ventricular fibrillation (P0.001).

Among patients who had in-hospital arrests during day or evening hours, survival was significantly lower on weekends than weekdays (17.4% versus 20.6%). Survival from in-hospital arrest at night was similar on weekends (14.8%) and weekdays (14.6).

The authors offered several potential explanations for the time-related differences in outcome: fewer supervisory personnel at night and on weekends; decreased hospital staffing at night and on weekends; use of less experienced healthcare personnel at night and on weekends; fewer hospital visitors to alert hospital staff when patients have cardiac arrests.

The findings are consistent with those of other studies.

"It is well documented that medical errors are higher at night," the authors said.

"Physicians have been shown to perform psychomotor tasks less proficiently at night and are more likely to commit errors than during the day," they added.

They pointed out that "our study could not definitively determine the absolute prevalence or timing of every cardiac arrest occurring in the hospital because the National Registry of Cardiopulmonary Resuscitation database does not capture the number of individuals in the hospital per hour and cannot guarantee that every cardiac arrest is reported to the registry."