title: Emergency department shift change is associated with pneumonia in patients with acute ischemic stroke.
abstract: OBJECTIVE
  Emergency department (ED) nurses play a pivotal role in early acute ischemic stroke patient management. We hypothesized that patients exposed to ED nursing shift changes (SC) may develop pneumonia (PNA) more frequently and have worse early outcomes than do patients who have continuity of care until stroke unit admission.
  
  
  METHODS
  Consecutive acute ischemic stroke patients presenting to our ED were studied using chart review and prospectively collected registry data. We evaluated the association of patient presence during an ED SC (ie, 07:00-08:00, 19:00-20:00) with length of stay in the ED, PNA rates, and early outcome measures (discharge disposition, modified Rankin Scale score, and death).
  
  
  RESULTS
  Three hundred sixty-six consecutive acute ischemic stroke patients met the criteria. Of those, 54.9% were present during an SC. After adjusting for baseline National Institutes of Health Stroke Scale, admission glucose, and intravenous tissue-type plasminogen activator, patients present during SC were half as likely to be discharged home or to inpatient rehab (OR, 0.50; 95% CI, 0.26-0.96; P=0.04) and were 2.5 times more likely to develop PNA (OR, 2.54; 95% CI, 1.02-6.30; P=0.045). After additional adjustment for time in the ED, the difference in favorable discharge disposition was no longer significant, but SC was associated with 5 times the odds of PNA (OR, 5.35; 95% CI, 1.34-21.39; P=0.018) compared with patients with continuity of care.
  
  
  CONCLUSIONS
  In our center, acute ischemic stroke patients present during an ED nursing SC experienced higher rates of PNA and had decreased rates of favorable discharge disposition compared with patients with continuity of care. Strategies to prevent PNA and improve hand-off communication during SC may reduce this risk.
authors: Stroke Program at Tulane University Hospital, Department of Neurology, 1415 Tulane Avenue, New Orleans, LA 70112, USA.
authors: Erica M
authors: EM
authors: Jones
authors: Karen C
authors: KC
authors: Albright
authors: Marco
authors: M
authors: Fossati-Bellani
authors: James E
authors: JE
authors: Siegler
authors: Sheryl
authors: S
authors: Martin-Schild
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000628:therapy*; D003266:Continuity of Patient Care / Q000592:standards; D003428:Cross Infection / Q000209:etiology; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000592:standards; D010561:Personnel Staffing and Scheduling / Q000592:standards; D011014:Pneumonia / Q000209:etiology*; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000628:therapy*