Attending Hospital at Night Or Weekends May be Associated with Treatment Delays

The time of day or night at which severely injured patients attend hospital has a huge impact on their treatment and prognosis, warn two senior doctors in this week’s BMJ.

This is because provision of key aspects of hospital trauma services such as staffing, access to operating theatres, and interventional radiology is reduced after normal working hours, say Paul Frost and Matt Wise, consultants in intensive care medicine at the University Hospital of Wales.

Their views follow the publication last month of a large trial to predict outcomes in patients with traumatic brain injury.

They point to a recent study that examined the process of care for 795 severely injured patients, 493 with head injury. Most presented to the accident and emergency department out of hours (18.00 – 07.59 hours or weekends).

It found that initial management of the patient was inappropriate in almost a quarter (23.5%) of cases when a senior house officer was the team leader or first reviewer compared with just 3% when a consultant performed this role.

Consultants were involved in 39.6% of cases during the day and only 11.5% of cases presenting at night. This trend was in the opposite direction for junior doctors, being highest during the night.

In addition to a lack of senior medical staff to coordinate management out of hours, immediate intervention for more specialised injuries was often unavailable.

Organisational deficiencies in out of hours care are not unique to the UK or to trauma care, they add. Increased mortality out of hours has also been identified in patients with heart attacks, cardiac arrest and patients being discharged from intensive care.

They believe that out of hours presentation to hospital may be associated with treatment delays and adverse outcomes and suggest that the time of hospital presentation should be considered when trying to predict outcome after severe injury.

Source: British Medical Journal

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