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

Abstract

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...

The Patterns and Impact of Off-Working Hours, Weekends and Seasonal Admissions of Patients with Major Trauma in a Level 1 Trauma Center

“…It is interesting to note that the same country data might provide different results at the national, regional, and institutional levels. Our observations agree with Hirose's findings in Japan and others, such as the report by Barbosa et al, USA [29], who reported increased mortality during nights but not on weekends, similar to this cohort.…”

Why do some trauma patients die while others survive? A matched-pair analysis based on data from Trauma Register DGU®

“…Barbosa et al. 11 showed in their single-centre study involving 563 patients that mortality was higher among patients treated at night despite risk adjustment. No statement was made about injury severity (e.g.…”

“…Some studies show that this factor does not have an aggravating effect, 7 , 8 , 9 , 10 while others show that it has a negative influence. 11 , 12 , 13…”

They only come out at night: Impact of time of day on outcomes after penetrating abdominal trauma

“…Barbosa et al, for example, identified that operative trauma was more likely to occur at night, over the weekends, and was associated with greater mortality in their Brazilian trauma population. More specifically, they identified admission at night as an independent risk factor for surgical mortality in trauma patients [ 1 ]. Studies in the United Kingdom and Canada conversely found no difference in mortality between patients presenting on nights and/or weekends compared to those arriving at “normal” hours, which may reflect their highly developed multihospital acute care and trauma system [ 2 , 3 ].…”

“…In fact, the current literature is divided regarding the effect of time of day on trauma patient outcomes. Multiple countries including Japan, Canada, the United Kingdom, Germany, Brazil, and the United States have all performed retrospective studies using their trauma data banks over varied time frames attempting to confirm or refute the above belief [ [1] , [2] , [3] , [4] , [5] , [6] ]. However, none of these studies can agree if time of day truly impacts patient outcomes, and none have separated blunt from penetrating trauma.…”