Analysis of nearly one million heart failure hospital admissions revealed late nights, Fridays, and January were particularly high-risk times for patient deaths.
In a new report in JAMA, researchers reveal that the riskiest times for patients with congestiveheart failure to die are late at night, on Fridays and in January. Their findings come from a 14-year big data population study involving 949,907 heart failure hospitalizations from all hospitals in New York State. David P. Kao, MD, of the University of Colorado, Denver, presented the study at the annual meeting of the Heart Failure Association of the European Society of Cardiology in Lisbon, Portugal.
According to experts, hospital staffing may be at the root of heart failure patient deaths, because when staffing was lowest, risk of dying was highest.
“In this era of increasing health care costs and health care reform, hospitals are being asked to trim budgets and cut staffing in order to remain solvent. The ultimate cost is the care of the patient,” said Kevin R. Campbell, MD, FACC, a cardiologist at UNC North Carolina and Health Care/Rex.
For example, Dr. Campbell said, “At night, the patient-to-nurse ratio is sometimes double what it is during the day. Additionally, the more experienced nursing staff is typically on the day shift due to seniority and the ability to make requests for better schedules. This leaves a lot of new grads on the floors alone at night and on weekends.”
Heart Failure Fridays
When the researchers broke down the data by season, week and hour, certain times emerged as significantly riskier for people with heart failure.
The peak month for hospital admission for heart failure was February, while the peak month for heart failure deaths in hospitals was January. Mondays were the safest days, with both lower rates of death and shorter hospital stays for heart failure patients. Fridays were the worst days. Crunching the hourly numbers, 6AM to noon was the least risky period of the day; highest risk times were midnight to 6AM, when odds of death increased 1.15 times and the length of average hospital stay increased by 1.4 days.
What can patients do to lessen their risks?
“For patients and families, it is imperative that you are vigilant when you are in the hospital with congestive heart failure. Patients and families should question all medications; ensure that they understand the plan of care, greet the nursing staff that comes on for the weekends and night shift, and make sure they understand your diagnosis and treatment goals,” said Campbell. “It may be a good idea to have a family member stay the night with an elderly or ill relative and check in frequently in the weekends,” he added.
Study investigator Dr. Kao urged hospitals to allocate more staff and resources during high-risk times to help reduce risks to patients in the future, in a press release.
More data from the study: Overall hospitalization trends showed that heart failure admissions increased by 1.1 admissions per day per year in New York from 1994 to 2007. In-hospital deaths went down by 0.3 percent per year and the length of stay decreased by 0.3 days per year, which shows that health outcomes and hospital use both improved a bit over the period covered by the study. Despite shorter hospital stays for heart failure, however, costs increased over this same time period, by $1,880 per hospital admission per year.