The witching time: diurnal patterns in adverse events of clinical management

Abstract

PurposeThe objective of this study is to investigate the existence of a diurnal pattern in the occurrence of adverse clinical management events.Design/methodology/approachThe approach takes the form of a retrospective record review of adverse clinical management events occurring in the 63 facilities of a statutory public health provider in rural south‐eastern Australia. Between January 2006 and December 2007, 2,463 clinical management incidents were reported by clinical staff to a specially designed database.FindingsAdverse clinical management incidents exhibit a marked diurnal pattern. This pattern was evident in both medicine and surgery as well as across facilities of differing acuity. The acrophase or peak of the daily cycle occurs at 14:30 hrs (95%CI 13:25 and 15:34 hrs). Although surgical events peaked earlier in the day (14.02hrs: 95%CI 12:32‐15:32) compared with medicine events (15:26hrs: 95%CI 13:07‐15:32), this difference was not statistically significant.Research limitations/implicationsAs the activity rate in the hospital is unknown, this finding study reports the time of the day when most adverse events occur and not their rate as a function of procedural volume.Practical implicationsThe existence of a diurnal pattern provides valuable information for strategies aimed at improving patient safety and health care quality. Interventions can now be more accurately targeted.Originality/valueThe paper is the first to move beyond descriptive data of the timing of adverse events and offers a model using chronobiological methods. The demonstration of the existence of diurnal patterns should improve programmes to reduce adverse events.

Diurnal variation of major error rates in the interpretation of abdominal/pelvic CT studies

“…In medical endeavors outside of radiology, diurnal variation of human performance has been verified in a range of tasks [6,10]. Adverse medical decision-making, for instance, have shown time of day variation for events such as unintentional injuries, diagnosis delays, and misidentification of a body part.…”

“…Adverse medical decision-making, for instance, have shown time of day variation for events such as unintentional injuries, diagnosis delays, and misidentification of a body part. The time of day where clinical performance was poorest was the mid-afternoon [6,10].…”

Effects of time of day on radiological interpretation

“…For example, Buckley, looking at adverse hospital events such as unintentional injuries, diagnosis delays, and misidentification of a body part during the day, showed that the time of day with the most influence on the likelihood of poor clinical performance was mid-afternoon. 70 Kelz et al 69 studied the relationship between the start time of surgical procedures and postoperative surgical complications, such as peripheral nerve injury, deep wound infection, and urinary tract infection. They found that surgical procedures starting between 4:00 p.m. and 6:00 p.m. had a higher rate of complications as compared to those starting between 7:00 a.m. and 4:00 p.m. and between 6:00 p.m. and 11:00 p.m. A study at Duke University Medical Center revealed an additional significant relationship between the start time of surgical procedures and anaesthetic complications, with the greatest number of adverse events occurring with procedures that began at 4:00 p.m. 71…”