Fever and many other symptoms of illness intensify in the later hours of the day. This is a fact of life for the sick, especially those unfortunate enough to be hospitalized, many of whom have been operated during the preceding sunlit hours. As the evening draws on there is fewer staff to attend patients. After dark is prime time for serious, even fatal hospital mistakes. Staff is cut even more on the night shift, let alone weekends and holidays.
The result is that mistakes multiply on the night shift and on weekends and holidays. Unfortunately hospital services, excluding ICU’s and ER’s are run like most businesses, “open” during daylight, and largely “closed” or at least attenuated on weekends and holidays. It is not surprising that more medication errors are made at night, more kids admitted at night were at increased risk, and a recent HealthGrades study showed that almost a quarter of a million patient deaths over a three-year period were preventable in terms of staffing. A 2005 study of 3.3 million births in California found that babies born late at night were 16 percent more likely to die than those born in the daytime. Other research found that patients going into cardiac arrest at night were more likely to die.
No hospital brochure talks about dangers after dark, only too well known to the medical world. There are reasons to feel anxious when entering a hospital, even though some improvements are being made in hospital staffing and services thanks to public outcry. The problems will remain endemic to the American hospital system, however, until thorny issues of resource allocation are solved: weekend and night rotation of non-professionals despite seniority, and round-the clock sharing of coverage by senior professional staff. Improvements cost money, of course, and and translate into higher medical costs for all of us. How much added financial burden is sustainable for an overburdened healthcare system remains a question I will attempt to address in future blogs.
Still, the time should have long passed when one cannot summon the night nurse, or a sleep-deprived intern is in charge until-or unless-his attending or senior resident can make it in for a critical patient. We get electricity and water 24/7, why not medical attention, in (or out of) hospitals?