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Does a patient's chance of surviving an inhospital cardiac arrest differ according to the time of day or day of week he experiences the event? Yes, according to a new study involving 86,748 adult, consecutive, inhospital cardiac arrests culled from the National Registry of Cardiopulmonary Resuscitation over a 7-year period. Researchers found that survival to discharge following inhospital cardiac arrest was lower when the event occurred during the night (11 p.m. to 6:59 a.m.) or on a weekend (11 p.m. Friday to 6:59 a.m. Monday). This held true even after data were corrected for various potentially confounding patient, arrest event, and hospital factors, including hospital size.
The only exceptions to these findings were emergency departments and trauma services. The study authors note that in these areas, attending or senior resident physicians are typically always available and that staffing tends to be uniform regardless of the time of day or day of week.
The authors suggest various factors that may contribute to lower survival rates at night and on weekends, including circadian differences in patients and staff, fewer health care professionals available to observe and respond to cardiac arrest, and the higher rate of medication errors at night. They also note that during the day and evening patients have more visitors, who may alert staff to impending problems. The authors call for more study to "focus on night and weekend hospital-wide resuscitation system processes of care that can potentially improve patient safety and survival following cardiac arrest."
Peberdy MA, et al., Survival from in-hospital cardiac arrest during nights and weekends, JAMA, February 20, 2008.
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