In what should not be a surprise to anyone, the New England Journal of Medicine published a study confirming that patients admitted at the tail end of the night shift have lower diagnostic accuracy, increased morbidity, mortality and an extended length of stay. Lead author of the study, Dr. Fenton Neal further elaborated….”Yep sucks being the 16th or 18th patient admitted in a 12 hour shift. No big surprise there.”
In a further commentary, study co-author, Dr. Rocky Ronium noted that patients admitted at the end of the night tend to have “crummy differentials”, “sloppier handwriting”, “more coffee spills on the chart” and “increased use of expletives in documentation”
Examined late admission charts revealed such Diagnostic and Therapeutic Considerations as:
“Same thing as the last four guys” “Undifferentiated dyspnea”
“No clue… Hope the day team can figure this out”
“Cant believe they dumped one more on me”
“Some Rheum or ID thing…. maybe Tetanus.. Ebola”
“Didn’t we admit him with the same thing last week”
“Lets scan everything and see what lights up”
“I’m still three admissions behind”
and “The bar opens in twenty minutes”
Late admission outcomes were miserable enough to compare to those of patients’ admitted first week of July or over a 3 day weekend. Further sub-group analysis revealed that late admits’ survival approached zero if the day team did not get to them before noon.
