[While Others are Sleeping - Performance of Major Trauma Care at Night].
Introduction:The literature indicates that medical staff suffer from a decline in cognitive and physical performance at night. This study evaluates the process quality and outcomes of emergency care during night-time and daytime.Method:Out of 1,226 prospectively registered patients, 420 were included into this study (observation period: 76 months). Inclusion criteria were an ISS ≥ 16 and admission to trauma room during "DAY" (8 am to 4 : 49 pm) or "NIGHT" (9 pm to 5 : 59 am). The fundamental part was the 130 items of the TraumaRegister DGU. The additional 350 items contain data about prehospital treatment, trauma room management and intensive care. Data were collected by a research assistant over a 24-h period.Results:The study sample contained 268 DAY-patients and 152 NIGHT-patients. Patients admitted during night were injured more severely: ISS 34.9 (± 16.4) vs. 31.1 (± 14.2), p = 0.015 and younger: 33.3 (± 16.6) vs. 43.6 (± 22.3) years old, p < 0.001. However, this had no impact on outcome prediction scores like RISC, RISC2 or TRISS, p ≥ 0.775. Furthermore, no difference in process quality was observed like the time to gain an arterial access: NIGHT 4.5 (± 3.7) vs. DAY 5.0 (± 3.7) min, p = 0.116, time for splinting 3.8 (± 3.7) vs. 3.4 (± 3.1) min, p = 0.922, or other parameters, like time to CT: 26.9 (± 11.2) vs. 26.6 (± 14.5) min, p = 0.520. Nor was there any difference in outcome: 17.8 % of the NIGHT-patients (RISC-prognosis: 23.8 %, SMR 0.74) died in hospital, and 18.3 % of the DAY-patients (RISC-prognosis: 24.0 %, SMR 0.77), p = 0.894. As well the comparison of the Glasgow Outcome Scale revealed no difference: NIGHT 3.8 (± 1.5) vs. DAY 3.8 (± 1.6), p = 0.491.Discussion:Although evidence suggests a drop of performance by medical staff at night, this effect could not be demonstrated. Considering this, the level of process quality and outcome - regardless of the time of arrival - remained constant on a high level. These results might be attributable to the quality management and the standardisation of the treatment.
Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Deutschland.
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Parsch
Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Deutschland.
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Hilber
Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Deutschland.
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Schmucker
Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Deutschland.
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Baumann
Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Deutschland.
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Nerlich
Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Deutschland.
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Ernstberger
D000293:Adolescent; D000328:Adult; D039602:After-Hours Care / Q000592:standards*; D000368:Aged; D002940:Circadian Rhythm; D015331:Cohort Studies; D003422:Critical Care / Q000592:standards; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D005858:Germany; D006302:Health Services Research; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D011785:Quality Assurance, Health Care / Q000592:standards; D012189:Retrospective Studies; D014193:Trauma Centers / Q000592:standards; D055986:Vital Signs; D055815:Young Adult