Hospital shift patterns influence stroke fatality
MedWire News: Stroke patients are more likely to die within 7 days if they are admitted to hospital at night or during the weekend, say Dutch researchers who also report a protective effect of the afternoon-to-evening shift handover.
"This study moves beyond the classical weekend/weekday classification," say Uzor Ogbu (University of Amsterdam) and colleagues. "We demonstrated what appears to be the presence of a baseline nighttime risk exacerbated during the weekend."
The weekday and weekend night shifts were associated with respective 54% and 71% increases in 7-day case-fatality, the team reports in the Journal of Neurology, Neurosurgery, and Psychiatry. The effect was significant and consistent for each individual weekday and weekend night shift.
The study of more than 82,000 patients, admitted to 115 hospitals between 2000 and 2004, also identified 20% and 31% increases in case-fatality associated with the Saturday and Sunday day shifts, respectively, relative to the Monday day shift.
The researchers suggest that the "relatively short and irregular nature of night shifts in hospitals" may prevent workers from adapting to night work, resulting in poorer cognitive performance and more medical errors.
The team then looked at the hour of admission, rather than the day or shift. This showed that the increased case-fatality risk occurred between midnight and 07.00.
It also revealed about a 25% reduction in case-fatality among patients admitted from the hours of 14.00 through 17.00. The association was significant for weekdays only, although there was a strong trend toward reduced case-fatality during this period at the weekend.
Ogbu et al note that this period coincides with the handover period between the day-shift and evening-shift workers. They say the reduced case-fatality could reflect a temporary boost in staff numbers and increased attention to detail during this period.
"The protective effect during the handover period would seem to reinforce that the number of staff available matters," they conclude.
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By Eleanor McDermid