What’s New in the Patient Safety World


October 2008        Hospital at Night Project



Hospital at Night Project


Our February 26, 2008 Patient Safety Tip of the Week “Nightmares….The Hospital at Night” mentioned one of the presentations at IHI’s Annual National Forum on Quality Improvement this past December “The Hospital at Night Program: Reducing Risks at Our Most Vulnerable Time of the Day” by David Gozzard and Carol Haraden. This described a redesign of hospital structure and processes in anticipation of a significant limitation of work hours imposed by the European Union (the European Working Time Directive). As part of the redesign they collected data on the tasks performed off-hours and found that many tasks performed by doctors at night could be redistributed to nonmedical staff and that many tasks could be performed during daytime hours. For instance, leaving space in the OR schedule for emergencies reduced delays in regularly scheduled cases and reduced the likelihood of doing overflow cases at night. They also focused on communication and handoffs and made greater use of SBAR and written reports that were discussed verbally. And they made better use of the MEWS (Modified Early Warning System) to identify patients at risk of deterioration. Preliminary, largely anecdotal, experiences with the program have been positive.


We said it would be most interesting to see the effect of this program on hard outcome measures. Well, the first report of outcomes of this project are available at the Hospital at Night project website. Outcomes to date have been modest. It does appear that implementation has reduced the number of deaths within 2 days of admission and the number of deaths within 2 days of surgery/procedure. And it did result in the need for fewer transfers externally to other hospitals. And there were some modest improvements in productivity and efficiency measures such as number of hospital beds and average length of stay. While the improvements to date are not eye-popping, we like the concept behind this program and hope that future outcome measurements will demonstrate the effort is worthwhile.












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