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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
  1. Emily J Robinsonl,
  2. Gary B Smith2,
  3. Geraldine S Power1,
  4. David A Harrison1,
  5. Jerry Nolan3,
  6. Jasmeet Soar4,
  7. Ken Spearpoint5,
  8. Carl Gwinnutt6,
  9. Kathryn M Rowan1
  1. 1Intensive Care National Audit & Research Centre, London, UK
  2. 2Faculty of Health and Social Sciences, University of Bournemouth, Bournemouth, UK
  3. 3Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
  4. 4Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
  5. 5Resuscitation Department, Imperial College Healthcare NHS Trust, London, UK
  6. 6Resuscitation Council (UK), London, UK
  1. Correspondence to Professor Gary B Smith, Faculty of Health and Social Sciences, University of Bournemouth, Royal London House, Christchurch Road, Bournemouth BH1 3LT, UK; gbsresearch{at}virginmedia.com

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.

  • Adverse events, epidemiology and detection
  • Audit and feedback
  • Patient safety
  • Mortality (standardized mortality ratios)
  • Hospital medicine

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Correction notice This article has been corrected since it was published Online First. The third author's name has been corrected.

  • Collaborators The National Cardiac Arrest Audit.

  • Contributors All authors contributed to the study design. Data were collected and cleaned as part of the UK National Cardiac Arrest Audit (NCAA). EJR, GSP and DAH analysed the data and produced the figures and table. All authors contributed to the interpretation of the results and drafting of the manuscript. All authors approved the final version of the manuscript.

  • Funding This project was supported by internal funding from the Resuscitation Council (UK) and the Intensive Care National Audit & Research Centre.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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