Survival From In-Hospital Cardiac Arrest During Nights and Weekends

Abstract

HE INSTITUTE OF MEDICINE RE-ports that as many as 98 000 preventable in-hospital deaths occur annually. 1 Diagnostic, treatment, preventive, and other system errors have been identified as focus areas to prevent medical injury. 2 The detection and treatment of arrests and their antecedents may be less effective at night because of patient, event, hospital, staffing, and response factors. If in-hospital cardiac arrests are more common or survival is worse on nights and weekends, this information could have important implications for hospital staffing, training, care delivery processes, and equipment decisions.We evaluated survival rates for adults with in-hospital cardiac arrest by time of day and day of week. We hypothesized that outcome after cardiac arrest would be worse during nights and weekends, even when adjusted for potentially confounding patient, event, and hospital factors.

In-hospital cardiac arrests: effect of amended Australian Resuscitation Council 2006 guidelines

“…24 We found a significant difference between initial rhythms for day and night time arrests with night time arrests having a higher number of initial non-shockable rhythms documented reflecting findings from other studies. 24 Our study has demonstrated that implementation of the ARC 2006 guidelines with an increased focus on minimally interrupted chest compressions has contributed to a trend towards improvement in survival to hospital discharge. Our results reflect other studies that examined the effect of implementing the amended guidelines.…”

“…17 Although our study identified age as a significant variable for survival to discharge it is considered a controversial prognostic factor. 18 Similar to our study previous research has shown that patients who arrest at night time have worse outcomes 20,23,24 and this is thought to be multi-factorial including differences in patients as well as health care staff, hospital staffing and operational factors. 24 We found a significant difference between initial rhythms for day and night time arrests with night time arrests having a higher number of initial non-shockable rhythms documented reflecting findings from other studies.…”

“…18 Similar to our study previous research has shown that patients who arrest at night time have worse outcomes 20,23,24 and this is thought to be multi-factorial including differences in patients as well as health care staff, hospital staffing and operational factors. 24 We found a significant difference between initial rhythms for day and night time arrests with night time arrests having a higher number of initial non-shockable rhythms documented reflecting findings from other studies. 24 Our study has demonstrated that implementation of the ARC 2006 guidelines with an increased focus on minimally interrupted chest compressions has contributed to a trend towards improvement in survival to hospital discharge.…”

Trends in Survival after In-Hospital Cardiac Arrest

“…To ensure that all cases in a hospital are captured, multiple case finding approaches are used including centralized collection of cardiac arrest flow sheets, review of hospital page system logs, and routine checks of code carts, pharmacy tracer drug records, and hospital billing charges for use of resuscitation medications. 13 The registry uses standardized Utstein-style definitions for defining clinical variables and outcomes. 14,15 Data completeness and accuracy is ensured by rigorous training and certification of hospital staff, use of standardized software with internal data checks and a periodic re-abstraction process.…”

Excellent Hospital Care for All: Open and Operating 24/7

“…[1][2][3] Nights and weekends are also associated with less aggressive care 4 higher rates of surgical complications 5 and medical errors, 6 and mortality from in-hospital cardiac arrest. 7 Factors cited as contributing to this disparity include skeleton medical and nursing coverage, often exacerbated by less experience, supervision, and patient familiarity than their weekday counterparts. 8,9 Limited specialized clinics, complex medical care, inter-professional expertise, and breakdowns in communication further compromise care during these times.…”