Why your hospital might have a problem with patient safety after hours and on the weekend
Categories: Site News, Patient Safety, Drafts, Public |
Posted: 10/03/2014 |
The Health Roundtable data shows that across Australia and NZ there is on average about a 10% higher SMR for patients admitted over a weekend
At our recent special Roundtable Associate Professor Daryl Jones, an intensive care specialist at the Austin Hospital, outlined some of the reasons why there might be a problem out of hours for some patients in our hospitals.
Possible ‘system’ reasons for less safe care after hours include fewer staff available with less experience which impacts on the timeliness and confidence of decision making; delays in detection of deterioration and diagnostic tests; less access to senior clinical review and definitive treatment; fatigue and poor environmental conditions contributing to potential errors; a lack of continuity with sub-optimal information transfer with handovers required for patients admitted overnight or on the weekend. There are also likely to be some patient factors such as increased illness severity and diurnal variations in physiology. It is important for hospitals to understand and measure the care they are providing to patients after hours and on the weekends.
Daryl also spoke to his research on the MET model of care which demonstrated a circadian variation of MET activation and cardiac arrest detection suggesting that detection of the deteriorating patient is much less frequent overnight. Hospitals need to be aware of their patterns of MET activation to ensure that there is appropriate 24 hour cover as “the more care givers that visit a patient the more likely they are to detect patient deteriorations ” [Michael De Vita]. There is evidence that patients who are deteriorating are not reliably recognised at night and so it is important for hospitals to measure diurnal variation of MET and Cardiac Arrest calls as well as calls by day of week. You can access copies of Daryl’s presentations below:
Admission and discharge out of hours
Detection of deterioration out of hours
MET and EoL care
Why there might be a problem out of hours