title: Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day: observational cohort study.
abstract: Internationally, hospital survival is lower for patients admitted at weekends and at night. Data from the UK National Cardiac Arrest Audit (NCAA) indicate that crude hospital survival was worse after in-hospital cardiac arrest (IHCA) at night versus day, and at weekends versus weekdays, despite similar frequency of events.
  
  
  
  To describe IHCA demographics during three day/time periods-weekday daytime (Monday to Friday, 08:00 to 19:59), weekend daytime (Saturday and Sunday, 08:00 to 19:59) and night-time (Monday to Sunday, 20:00 to 07:59)-and to compare the associated rates of return of spontaneous circulation (ROSC) for >20 min (ROSC>20 min) and survival to hospital discharge, adjusted for risk using previously developed NCAA risk models. To consider whether any observed difference could be attributed to differences in the case mix of patients resident in hospital and/or the administered care.
  
  
  
  We performed a prospectively defined analysis of NCAA data from 27 700 patients aged ≥16 years receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a resuscitation (2222) call in 146 UK acute hospitals.
  
  
  
  Risk-adjusted outcomes (OR (95% CI)) were worse (p<0.001) for both weekend daytime (ROSC>20 min 0.88 (0.81 to 0.95); hospital survival 0.72 (0.64 to 0.80)), and night-time (ROSC>20 min 0.72 (0.68 to 0.76); hospital survival 0.58 (0.54 to 0.63)) compared with weekday daytime. The effects were stronger for non-shockable than shockable rhythms, but there was no significant interaction between day/time of arrest and age, or day/time of arrest and arrest location. While many daytime IHCAs involved procedures, restricting the analyses to IHCAs in medical admissions with an arrest location of ward produced results that are broadly in line with the primary analyses.
  
  
  
  IHCAs attended by the hospital-based resuscitation team during nights and weekends have substantially worse outcomes than during weekday daytimes. Organisational or care differences at night and weekends, rather than patient case mix, appear to be responsible.
authors.affiliation: Intensive Care National Audit & Research Centre, London, UK.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Robinson
authors.affiliation: Faculty of Health and Social Sciences, University of Bournemouth, Bournemouth, UK.
authors.forename: Gary B
authors.identifier: 0000-0003-2070-8455
authors.initials: GB
authors.lastname: Smith
authors.affiliation: Intensive Care National Audit & Research Centre, London, UK.
authors.forename: Geraldine S
authors.initials: GS
authors.lastname: Power
authors.affiliation: Intensive Care National Audit & Research Centre, London, UK.
authors.forename: David A
authors.identifier: 0000-0002-9002-9098
authors.initials: DA
authors.lastname: Harrison
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK.
authors.forename: Jerry
authors.initials: J
authors.lastname: Nolan
authors.affiliation: Department of Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK.
authors.forename: Jasmeet
authors.initials: J
authors.lastname: Soar
authors.affiliation: Resuscitation Department, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Ken
authors.initials: K
authors.lastname: Spearpoint
authors.affiliation: Resuscitation Council (UK), London, UK.
authors.forename: Carl
authors.initials: C
authors.lastname: Gwinnutt
authors.affiliation: Intensive Care National Audit & Research Centre, London, UK.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Rowan
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003953:Diagnosis-Related Groups; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D012959:Socioeconomic Factors; D013997:Time Factors; D006113:United Kingdom
keywords: Adverse events, epidemiology and detection; Audit and feedback; Hospital medicine; Mortality (standardized mortality ratios); Patient safety