Night-shift staffing another issue in patient safety

"People get sick 24 hours a day, but there is a stark discrepancy in the quality of care on nights and weekends" when 50% to 70% of patients may be admitted, says David Shulkin, chief executive of New York's Beth Israel Medical Center."

An interesting (and alarming) article by The Wall Street Journal columnist Laura Landro raises another issue in the plight to increase patient safety (and decrease preventable medical errors)...namely the high risk of low-staffed hospital night shifts. According to Landro:

"Hospitals are waking up to the fact that substandard care on nights and weekends is endangering patients -- giving new meaning to the term 'graveyard shift.'

Patients suffer higher rates of death, complications and medical errors when they are treated during thinly staffed off hours. Now, some hospitals are taking steps to improve safety and reduce their own legal liability from mishaps.

Institutions that long relied on having doctors on call at home are hiring physicians known as nocturnists, who work only night shifts. Some hospitals have begun staffing intensive-care units round-the-clock with critical-care specialists who do double-duty coping with a crisis anywhere in the hospital. And new policies are being put in place to improve communications at the hand-off between the day and night shifts."

The Society of Hospital Medicine reports that last year about 1,200 hospitals had either a nocturnist or hospitalist sharing the coverage--compared with just 700 four years earlier, a dramatic 70%+ increase. Moreover, a study published in the journal Circulation cited that more than half of 62,814 heart-attack patients arrived at night...exactly when the coverage is compromised. Moreover, this group is 66% less likely than daytime patients to receive an angioplasty, a procedure to open clogged arteries that the American Heart Association recommends occur within a 90-minute window.

Currently, right at 6% of the nation's 22,000 hospitalists are nocturnists and those without night doctors result in patients waiting until the next day to see the "day" doctor as Emergency Room Doctor roles are centered more on triage. Conversely, as Landro's article points out, "Teaching hospitals have long relied on medical residents and interns for overnight duty. But changes in work rules in recent years have forced them to reduce the number of hours medical trainees can work. This has resulted in shorter shifts and more frequent "hand-offs" of patients between shifts."

As for after-hour care risks? According to several studies, it's well documented. There are higher death rates for stroke patients who arrive at the hospital at night, as well as for patients already in the hospital who suffer cardiac arrests. Ergo, it's not only caregivers' practices and hygiene protocols that need to be improved to ensure better care and few victims of medical errors. And while patient safety technologies work 24/7, administrators will need to identify how to responsibly staff around the clock as well.

Full article with more information worth reading is located here.