LO48: Evaluation of the effect of nightshifts on patient outcomes: a multi-center study

Abstract

Introduction: Nightshifts may represent a more challenging work environment due to staff fatigue. Our objective was to determine if an association exists between health outcomes for patients seen in Calgary Zone Emergency Department (ED) during nightshifts as compared to other time periods. Methods: Administrative data from a city-wide electronic health record was collected from four urban EDs on all discharged patients during a 2-year period: January 2015-December 2016. A total of 454,125 patient visits were included and patients with a scheduled return to the ED were excluded. Three primary outcomes were selected to assess the effects of night shifts on the quality of care received by patients in the ED at night; (i) unscheduled returns to the ED within 7 days resulting in admission, (ii) mortality within 48 hrs and, (iii) mortality within 7 days of being seen by a physician. Non-night shifts were defined as patients seen on day and evening or 700-2300. The data was analyzed using descriptive statistics and precision reported via 95% confidence intervals. Results: For the outcome of returns resulting in admission, a 2.6% rate was noted for patients seen at night compared to 2.3% during non-night; OR 1.15 (95% CI 1.09-1.21). Furthermore, patients seen at night had a 0.033% rate of death, while non-night patients had a 0.022% chance of death within 48 hrs of discharge; OR 1.53 (95% CI 0.98-2.38). For mortality within 7 days, the rate of death observed was 0.10% and 0.078% respectively; OR 1.24 (95% CI 0.97-1.60). Conclusion: Our study identified presenting to the ED at night as a potential risk factor for adverse patient outcomes using 3 primary quality of care indicators. An adjusted analysis is needed to account for potential confounding variables and effect modifiers and is underway.