Impact of Time of Presentation on the Care and Outcomes of Acute Myocardial Infarction

Jneid, Hani; Fonarow, Gregg C.; Cannon, Christopher P.; Palacios, Igor F.; Kılıç, Teoman; Moukarbel, George V.; Maree, Andrew O.; LaBresh, Kenneth A.; Li, Liang; Newby, L. Kristin; Fletcher, Gerald F.; Wexler, Laura; Peterson, Eric D.

doi:10.1161/circulationaha.107.752113

Cited by 126 publications

(149 citation statements)

References 23 publications

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“…Specific studies in patients with acute myocardial infarction, ischemic stroke and the Intensive Care Units showed higher rate of clinical complications and hospital mortality in the "off-hours" periods (nighttime or weekends) [4][5][6][7][8][9][10][11][12] . The volume of evidence demonstrating higher incidence of unfavorable outcomes in these adverse conditions weakens the idea of occasional errors as the cause of these events [4][5][6][7][8][9][10] . This highlights the need to analyze these situations trough of a model to interpret the error with a systemic view.…”

mentioning

confidence: 99%

“…The cumulative presence of a number of unfavorable conditions is remarkable and very common in these periods, situations that favor and increase vulnerability to error [1][2][3][4][5][6][7][8][9][10] . Specific studies in patients with acute myocardial infarction, ischemic stroke and the Intensive Care Units showed higher rate of clinical complications and hospital mortality in the "off-hours" periods (nighttime or weekends) [4][5][6][7][8][9][10][11][12] . The volume of evidence demonstrating higher incidence of unfavorable outcomes in these adverse conditions weakens the idea of occasional errors as the cause of these events [4][5][6][7][8][9][10] .…”

mentioning

confidence: 99%

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Night admission is an independent risk factor for mortality in trauma patients - a systemic error approach

Barbosa

Júnior

Chaves

et al. 2015

Rev. Col. Bras. Cir.

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Night admission is an independent risk factor for mortality in Night admission is an independent risk factor for mortality in Night admission is an independent risk factor for mortality in Night admission is an independent risk factor for mortality in Night admission is an independent risk factor for mortality in trauma patients -a systemic error approach trauma patients -a systemic error approach trauma patients -a systemic error approach trauma patients -a systemic error approach trauma patients -a systemic error approach Admissão noturna é fator de risco independente para mortalidade em pacientes Admissão noturna é fator de risco independente para mortalidade em pacientes Admissão noturna é fator de risco independente para mortalidade em pacientes Admissão noturna é fator de risco independente para mortalidade em pacientes Admissão noturna é fator de risco independente para mortalidade em pacientes vítimas de trauma -uma abordagem ao erro sistêmico vítimas de trauma -uma abordagem ao erro sistêmico vítimas de trauma -uma abordagem ao erro sistêmico vítimas de trauma -uma abordagem ao erro sistêmico vítimas de trauma -uma abordagem ao erro sistêmico LEONARDO DE [1][2][3] . Fatigue and lack of supervision to attending physicians may contribute to increased complications and hospital mortality. Such situations, also added to the circadian rhythm and dynamics of abnormal operating changes can be crucial factors for the worst performance in these periods. The cumulative presence of a number of unfavorable conditions is remarkable and very common in these periods, situations that favor and increase vulnerability to error [1][2][3][4][5][6][7][8][9][10] . Specific studies in patients with acute myocardial infarction, ischemic stroke and the Intensive Care Units showed higher rate of clinical complications and hospital mortality in the "off-hours" periods (nighttime or weekends) [4][5][6][7][8][9][10][11][12] . The volume of evidence demonstrating higher incidence of unfavorable outcomes in these adverse conditions weakens the idea of occasional errors as the cause of these events [4][5][6][7][8][9][10] . This highlights the need to analyze these situations trough of a model to interpret the error with a systemic view.Due to the lack of Brazilian studies, this study aimed to verify the impact of the shift of admission of patients who have suffered trauma, underwent surgery, in hospital mortality. According to these results, interpretation models and error correction are discussed. METHODS METHODS METHODS METHODS METHODSThis is a cohort study with retrospective collection of data, which were selected through electronic medical records, patients admitted from November 2011 to March 2012 in the emergency of Hospital do Subúrbio (HS) -a public hospital attending urgency and emergency and public-private administrative nature, in Subúrbio Ferroviá-rio, district of the city of Salvador, Bahia. The study included trauma patients admitted to the emergency HS who underwent surgery and were classified according to Internatio...

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confidence: 99%

mentioning

confidence: 99%

Night admission is an independent risk factor for mortality in trauma patients - a systemic error approach

Barbosa

Júnior

Chaves

et al. 2015

Rev. Col. Bras. Cir.

View full text Add to dashboard Cite

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“…presenting during the night; outcomes, however, differ regarding in-hospital mortality [3][4][5][6][7] .…”

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confidence: 99%

Hora da admissão na unidade de emergência e mortalidade hospitalar na síndrome coronária aguda

Takada¹,

Roza²,

Ramos³

et al. 2012

Arq. Bras. Cardiol.

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] A number of prior analyses have suggested that the introduction of care components similar to elements in our intervention may lead to reductions in hospital length of stay. For instance, improved night and weekend physician coverage has been associated with reduced length of stay.…”

Section: Discussionmentioning

confidence: 99%

“…Compared to care on weekdays, care on weekends has been associated with delays, 1,2 decreased intensity, 3,4 and poorer performance on quality-of-care metrics such as time to reperfusion for acute myocardial infarction and completion of discharge instructions. [5][6][7][8][9][10][11] This variability in care may have important clinical implications, as weekends in the hospital have been associated with increased mortality. [8][9][10][11][12][13][14][15] At our medical center, we observed that the number of discharges was substantially lower on weekends than on weekdays.…”

Section: Introductionmentioning

confidence: 99%

Impact of an Intervention to Improve Weekend Hospital Care at an Academic Medical Center: An Observational Study

et al. 2015

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BACKGROUND: Hospital care on weekends has been associated with delays in care, reduced quality, and poor clinical outcomes. OBJECTIVE: The purpose of this study was to evaluate the impact of a weekend hospital intervention on processes of care and clinical outcomes. The multifaceted intervention included expanded weekend diagnostic services, improved weekend discharge processes, and increased physician and care management services on weekends. DESIGN AND PATIENTS: This was an interrupted time series observational study of adult non-obstetric patients hospitalized at a single academic medical center between January 2011 and January 2014. The study included 18 months prior to and 19 months following the implementation of the intervention. Data were analyzed using segmented regression analysis with adjustment for confounders. MAIN MEASURES: The primary outcome was average length of stay. Secondary outcomes included percent of patients discharged on weekends, 30-day readmission rate, and in-hospital mortality rate. KEY RESULTS: The study included 57,163 hospitalizations. Following implementation of the intervention, average length of stay decreased by 13 % (95 % CI 10-15 %) and continued to decrease by 1 % (95 % CI 1-2 %) per month as compared to the underlying time trend. The proportion of weekend discharges increased by 12 % (95 % CI 2-22 %) at the time of the intervention and continued to increase by 2 % (95 % CI 1-3 %) per month thereafter. The intervention had no impact on r e a d m i s s i o n s o r m o r t a l i t y. D u r i n g t h e p o s timplementation period, the hospital was evacuated and closed for 2 months due to damage from Hurricane Sandy, and a new hospital-wide electronic health record was introduced. The contributions of these events to our findings are not known. We observed a lower inpatient census and found differences in patient characteristics, including higher rates of Medicaid insurance and comorbidities, in the post-Hurricane Sandy period as compared to the pre-Sandy period. CONCLUSIONS:The intervention was associated with a reduction in length of stay and an increase in weekend discharges. Our longitudinal study also illuminated the challenges of evaluating the effectiveness of a large-scale intervention in a real-world hospital setting.

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Impact of Time of Presentation on the Care and Outcomes of Acute Myocardial Infarction

Cited by 126 publications

References 23 publications

Night admission is an independent risk factor for mortality in trauma patients - a systemic error approach

Night admission is an independent risk factor for mortality in trauma patients - a systemic error approach

Hora da admissão na unidade de emergência e mortalidade hospitalar na síndrome coronária aguda

Impact of an Intervention to Improve Weekend Hospital Care at an Academic Medical Center: An Observational Study

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