Study: "Code Blue" Deadliest Late At Night

Patients Who Suffer Cardiac Arrest In Hospital More Likely To Die During Graveyard Shift

(AP)  Many hospitals call it "code blue," a signal given over the intercom when a patient's heart has stopped. When code blue works well, a team speeds to the bedside and revives the patient.

The graveyard shift is the worst time to call code blue, a new study finds. Patients who go into cardiac arrest while in the hospital are more likely to die if it happens after 11 p.m., when staffing may be lower or patients watched less closely.

"Our findings should be a pretty big wakeup call to urge hospitals to critically evaluate how they are performing resuscitation," said the study's lead author, Dr. Mary Ann Peberdy of the Virginia Commonwealth University Health System in Richmond. "It may well be possible that there is a less effective and less efficient response at night."

The study, appearing in Wednesday's Journal of the American Medical Association, didn't examine why days and overnights differed. But researchers found among the late night cases a higher portion of instances where patients were discovered with no heart electrical activity, that is, too late to deliver a lifesaving shock.

Staff who are fatigued, less experienced or too few in number could be to blame, researchers speculated. Weekends had lower survival rates than weekdays, but the difference wasn't as pronounced as between late night and daytime hours.

Only in the emergency room was there no night-or-day difference in survival.

The study was based on an analysis of more than 86,000 cardiac arrests in more than 500 hospitals over seven years.

There were 58,593 cardiac arrests during the day or evening. Of those, 11,604, almost 20 percent, survived to leave the hospital. There were 28,155 cardiac arrests during the shift that began at 11 p.m. Of those, 4,139, fewer than 15 percent, survived for discharge.

After taking into account other factors associated with survival, the researchers still found the chances of surviving until discharge 18 percent lower if the cardiac arrest was during the period from 11 p.m. to 6:59 a.m.

(Past studies have found that, overall, 80 to 85 percent of patients who suffer a cardiac arrest in the hospital die in the hospital.)

"Everyone who works in a hospital is going to look at this and say, 'Are we doing everything we should be?"' said Dr. Charles Porter, a cardiologist at the University of Kansas Hospital in Kansas City, Kansas. There, automated external defibrillators, or AEDs, are readily available and any staff member, even a custodian, can summon a rapid response team if a patient doesn't look good.

A study last month found that being in the hospital was no guarantee of getting prompt treatment for cardiac arrest. In that study, published in the New England Journal of Medicine, researchers found that one-third of patients don't get a potentially live-saving shock within the recommended two minutes.

[random_radar]

80-85% of patients who suffer a heart attack in the hospital die in the hospital. Ladies and gentlemen, it doesn''t really matter whether you have a heart attack in the day or night, you are probably going to die.

[xlib]

This is not new news, folks. IT has always been this way. News flash, the government running health care will not solve this problem.
psk123-your post isn''t saying anything new either.
There is and has been for a umber of years a growing nursing shortage. Think folks, if you are in a hospital it is because you need nursing care. That''s it, nothing more. Young people are not going into nurisng today because there are other lucrative professions out there that do not workd 24/7/365. If you practice in a hospital you do your share of weekends and holidays.
So, cbs, what''s your solution.?
To just say "increase staffing" is so simplistic. YOu have to have trained professional staff available.
I know, let the government demand that certain people go into nursing-there''s a democratic, liberal solution for you.
Don''t laugh, with this group of democratics, could happen.

[meinnv]

Hospitals need to increase staff in response to meet patient needs and to decrease this alarming trend. But in today''s age when managers are concerned about bonuses and hospitals are concerned about costs, that is not likely to happen.

[meinnv]

The study, appearing in Wednesday''s Journal of the American Medical Association, didn''t examine why days and overnights differed.

I can tell you....lower staffing at night (the 7pm to 7am shift) than during the day, at least at the hospital my mother works at. They have what is known as a staffing guideline. The fewer the patients on a floor or unit, the fewer nursing staff. The only reason an ER doesn''t change their staffing is that it has a constant flux of patients coming in with different needs, unlike a specialized unit--medical/surgical or pediatrics.

[meinnv]

At the hospital where my mom works, the staffing is lower at night than during the day. Always has been, and they are in no hurry to change it. In many cases the night nurses have 8-9 patients, as opposed to day shift nurses with 5-6 patients. Also, at night, the nurses are not always at the desk, and if there is a clerk on, the clerk has to answer the light and then get the patient''s nurse, that accounts for the length of time in the response time. I have been there in person and seen it. If there is no clerk, and the nurses are not at the station, then there is an even longer wait.Doesn''t make it right though. It is not the nurses'' fault with regard to staffing, but the hospital management who care more about saving money than being there for the patients.

[psk123-2009]

I have found that if you hit that call button late at night it takes 3 to 4 times longer before you get a response from the nurse''s desk than if you hit it during the day. They seem to be really put out that you would have that kind of nerve to disturb them when you should be asleep.