Dying on the Night Shift

Hospital patients who suffer cardiac arrest at night are more likely to die than patients whose hearts stop on the day shift, a new study shows.

The study, published today in The Journal of the American Medical Association, is the latest to show that patient care and survival appears to be profoundly affected by hospital timing and staffing issues. Other studies have shown that patients who receive hospital care on weekends do worse than patients treated during the regular workweek.

Cardiac arrest occurs when the heart stops beating suddenly, and it can be triggered by a heart attack or other emergencies like blood loss or respiratory problems. When a patient suffers cardiac arrest in a hospital, a “Code Blue” is typically called, and a team of doctors and nurses rushes to the bedside with a “crash cart” equipped with a defibrillator, drugs and other tools used to restart a stopped heart.

The current study examined cardiac arrests among 86,748 adult hospital patients at 507 hospitals during a seven-year period ending last February. The researchers compared survival rates by the time of day and day of the week that cardiac arrest occurred. Among patients who had cardiac arrest between 11 p.m. and 7 a.m., only 15 percent survived long enough to be discharged. That compares to about 20 percent of day-shift cardiac arrest patients who were discharged. Other measures, including 24-hour survival and favorable neurological outcomes, also were worse if the patient had a heart attack at night. The study also confirmed earlier research showing that weekday cardiac arrest survival was better than if cardiac arrest occurred on weekends.

The reality is that a patient whose heart stops in the hospital is typically very sick, and even among patients who have cardiac arrest during the day shift, survival rates are low. However, the data suggest that something changes at night that makes it less likely a stopped heart will be restarted. It may be that patients aren’t checked as often or that there aren’t as many staffers in the hospital to respond quickly to emergencies. Or it may suggest the skill and experience level of night hospital workers is lower than that of workers on the day shift.