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Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day : observational cohort study
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Robinson, Emily J., Smith, Gary B., Power, Geraldine S., Harrison, David A., Nolan, Jerry P., Soar, Jasmeet, Spearpoint, Ken, Gwinnutt, Carl and Rowan, Kathryn M. (2015) Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day : observational cohort study. BMJ Quality & Safety, 25 (11). pp. 832-841. doi:10.1136/bmjqs-2015-004223 ISSN 2044-5415.
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Official URL: http://dx.doi.org/10.1136/bmjqs-2015-004223
Abstract
Background
Internationally, hospital survival is lower for patients admitted at weekends and at night. Data from the UK National Cardiac Arrest Audit (NCAA) indicate that crude hospital survival was worse after in-hospital cardiac arrest (IHCA) at night versus day, and at weekends versus weekdays, despite similar frequency of events.
Objective
To describe IHCA demographics during three day/time periods—weekday daytime (Monday to Friday, 08:00 to 19:59), weekend daytime (Saturday and Sunday, 08:00 to 19:59) and night-time (Monday to Sunday, 20:00 to 07:59)—and to compare the associated rates of return of spontaneous circulation (ROSC) for >20 min (ROSC>20 min) and survival to hospital discharge, adjusted for risk using previously developed NCAA risk models. To consider whether any observed difference could be attributed to differences in the case mix of patients resident in hospital and/or the administered care.
Methods
We performed a prospectively defined analysis of NCAA data from 27 700 patients aged ≥16 years receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a resuscitation (2222) call in 146 UK acute hospitals.
Results
Risk-adjusted outcomes (OR (95% CI)) were worse (p<0.001) for both weekend daytime (ROSC>20 min 0.88 (0.81 to 0.95); hospital survival 0.72 (0.64 to 0.80)), and night-time (ROSC>20 min 0.72 (0.68 to 0.76); hospital survival 0.58 (0.54 to 0.63)) compared with weekday daytime. The effects were stronger for non-shockable than shockable rhythms, but there was no significant interaction between day/time of arrest and age, or day/time of arrest and arrest location. While many daytime IHCAs involved procedures, restricting the analyses to IHCAs in medical admissions with an arrest location of ward produced results that are broadly in line with the primary analyses.
Conclusions
IHCAs attended by the hospital-based resuscitation team during nights and weekends have substantially worse outcomes than during weekday daytimes. Organisational or care differences at night and weekends, rather than patient case mix, appear to be responsible.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > RC Internal medicine | |||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Cardiac arrest -- Treatment, CPR (First aid), Hospitals -- Admission and discharge | |||||||||
| Journal or Publication Title: | BMJ Quality & Safety | |||||||||
| Publisher: | BMJ Publishing Group Ltd. | |||||||||
| ISSN: | 2044-5415 | |||||||||
| Official Date: | 11 December 2015 | |||||||||
| Dates: |
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| Volume: | 25 | |||||||||
| Number: | 11 | |||||||||
| Page Range: | pp. 832-841 | |||||||||
| DOI: | 10.1136/bmjqs-2015-004223 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Access rights to Published version: | Open Access (Creative Commons) | |||||||||
| Date of first compliant deposit: | 6 February 2019 | |||||||||
| Date of first compliant Open Access: | 7 February 2019 | |||||||||
| RIOXX Funder/Project Grant: |
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