Mortality and readmission differences associated with after-hours hospital admission: A population-based cohort study in Queensland Australia.

Background and Aims: Policy makers and health system managers are seeking evidence on the risks involved for patients associated with after-hours care. This study of approximately 1 million patients who were admitted to the 25 largest public hospitals in Queensland Australia sought to quantify mortality and readmission differences associated with after-hours hospital admission. Methods: Logistic regression was used to assess whether there were any differences in mortality and readmissions based on the time inpatients were admitted to hospital (after-hours versus within hours). Patient and staffing data, including the variation in physician and nursing staff numbers and seniority were included as explicit predictors within patient outcome models. Results: After adjusting for case-mix confounding, statistically significant higher mortality was observed for patients admitted on weekends via the hospital's emergency department compared to within hours. This finding of elevated mortality risk after-hours held true in sensitivity analyses which explored broader definitions of after-hours care: an "Extended" definition comprising a weekend extending into Friday night and early Monday morning; and a "Twilight" definition comprising weekends and weeknights.There were no significant differences in 30-day readmissions for emergency or elective patients admitted after-hours. Increased mortality risks for elective patients was found to be an evening/weekend effect rather than a day-of-week effect. Workforce metrics that played a role in observed outcome differences within hours/after-hours were more a time of day rather than day of week effect, i.e. staffing impacts differ more between day and night than the weekday versus weekend. Conclusion: Patients admitted after-hours have significantly higher mortality than patients admitted within hours. This study confirms an association between mortality differences and the time patients were admitted to hospital, and identifies characteristics of patients and staffing that affect those outcomes.

The Effect of COVID-19 Fear in Patients and Clinical Nurses on Night Nursing Care.

This study was conducted with the aim of determining the effect of fear of COVID-19 in patients and clinical nurses on night nursing care. This was a cross-sectional study. The research sample consisted of 604 patients and 270 clinical nurses selected by the convenience sampling method. Data were collected between August 2021 and July 2022 using a Patients' Information form, a Nurse's Information form, the Fear of COVID-19 scale, and the Night Nursing Care instrument. No significant difference was found between the total mean scores of the patients and the nurses on the Fear of COVID-19 scale or the Night Nursing Care instrument (rho = -0.017, p = .702; rho = -0.020, p = .741). It was found that patients' and nurses' fears of COVID-19 did not affect their perceptions of night nursing care.

[Sleep quality and mental well-being of mothers caring for children with disabilities and requiring oxygen therapy and night care at home].

Objectives　This study aimed to 1) determine what kind of care for children with disabilities is related to the mothers' sleep and mental well-being and 2) objectively measure the sleep state of mothers responsible for children with disabilities.Methods　A self-administered questionnaire was distributed to 180 mothers of children enrolled in the Special Needs Education School in prefecture A. Amongst these, nine who provided consent underwent objective sleep measurements using actigraphy. The questionnaire investigated the lifestyle and the type of care needed for children with disabilities and their influence on the mothers. Subjective sleep quality (Pittsburgh Sleep Quality Index) and mental well-being status (General Health Questionnaire) of the mothers were also evaluated. Logistic regression analysis was performed to analyze the background factors affecting sleep quality and mental health.Results　Of the 180 participants, 84 (46.7%) provided valid responses. Fifty-two (64.2%) and 34 (42.0%) individuals subjectively reported poor sleep quality and poor mental well-being, respectively. Mothers having responsibilities of oxygen therapy and night care reported significantly poor sleep quality and mental well-being. Moreover, objective sleep measurements showed that the changes in the child's physical condition, such as ventilator management, epileptic seizures, and fever, resulted in prolonged waking times and affected the sleep efficiency of the mother.Conclusion　Responsibilities toward providing oxygen therapy and night care for their children with disabilities influenced the sleep quality and mental well-being of the mothers. Thus, it is important to provide support to mothers caring such disabled children.

Environmental factors related to sleep latency among inpatients in rehabilitation wards according to functional independence measure cognitive scores.

BACKGROUND: No study has investigated sleep-related environmental factors in patients according to their functional independence measure (FIM) cognitive scores. AIMS: The aim of this study is to examine the associations between environmental factors such as noise and sleep latency according to the FIM cognitive scores among inpatients in rehabilitation wards. DESIGN: This is a prospective longitudinal study. METHODS: This study measured the sleep state using a bed-based actigraphy, environmental data from Environmental Sensor®, and medical record information of 33 inpatients in the rehabilitation wards during 2018. A linear mixed-effect model was used to analyse the associations between sleep latency and environmental factors. Participants were grouped according to high or low FIM cognitive scores. RESULTS: The average patient age was 77.2 ± 10.9 years, and 48.5% were male. In the high FIM cognitive score group, the loudness and frequency of noise exceeding 40 dB during sleep latency were significantly associated with sleep latency. In the low FIM cognitive score group, only the noise frequency was associated with sleep latency, and intra-individual variance was larger than that of the high group. CONCLUSION: These findings suggest that providing night care with attention to subdued noise is important, particularly for patients with low cognitive functional independence levels measured by the FIM cognitive score.

After-hours emergency department care: Does time or day of arrival affect survival?

OBJECTIVE: To determine whether after-hours presentation to EDs is associated with differences in 7-day and 30-day mortality. The influence of patient case-mix and workforce staffing differences are also explored. METHODS: We conducted a retrospective observational study of 3.7 million ED episodes across 30 public hospitals in Queensland, Australia during May 2013-September 2015 using routinely collected hospital data linked to hospital staffing data and the death registry. Episodes were categorised as within/after-hours using time of presentation. Staffing was derived from payroll records and explored by defining 11 staffing ratios. RESULTS: Weekend presentation was slightly more associated (7-day mortality odds ratio 1.05, 95% confidence interval [CI] 1.01-1.10) or no more associated (30-day mortality odds ratio 1.01, 95% CI 0.98-1.03) with death than weekday presentation. When weeknights are included in the 'after-hours' period, odds ratios are smaller, so that after-hours presentation is no more associated (7-day mortality odds ratio 1.03, 95% CI 0.99-1.08) or less associated (30-day mortality odds ratio 0.95, 95% CI 0.93-0.97) with death. No significant after-hours patient case-mix differences were observed between weekday and weekend presentations for 7-day mortality. In other combinations of outcome and after-hours definition, some differences (especially measures relating to severity of presenting condition) were found. Staffing ratios were not strongly associated with any within/after-hours differences in ED mortality. CONCLUSIONS: After-hours presentation on the weekend to an ED is associated with higher 7-day mortality even after controlling for case-mix.

Nurse staffing in large general hospitals in China: an observational study.

BACKGROUND: The appropriate staffing of nurses not only reflects the situation of nursing management of human resource, but also is related to the nursing quality in hospitals. This study investigated the staffing of nurses in large general hospitals in China. METHODS: In this study, a database established by the National Centre for Nursing Care Quality Control, which conducted a national survey of the staffing of nurses in China mainland in 2017, was analysed. The time-point survey data of 20 375 departments in 668 large general hospitals in China were obtained, including the information of nurses and patients during the day (10:00 am) and at night (10:00 pm). Then, the staffing of nurses was evaluated by calculating the nurse to patient ratio (the average number of patients assigned to a nurse, NTP ratio). The Kruskal-Wallis test was performed to compare the NTP ratios during the day and at night among different regions and departments. RESULTS: In large general hospitals, a nurse takes care of eight patients (NTP ratio = 1:8.0) during the day and 23 patients at night (NTP ratio = 1:23) on average. There were significant differences between day and night. In terms of different regions, a nurse in the hospitals in the western region takes care of 7.8 patients during the day (NTP ratio = 1:7.8) on average, and the nursing resource in the western region is more adequate than that in the eastern (1:8.0) and central (1:8.0) regions. At night, the eastern region has a higher level of NTP (1:23.0). In terms of departments, a nurse working in the ICU takes care of two patients during the day (NTP ratio = 1:2.0) and 2.9 patients at night (NTP ratio = 1:2.9). The level of NTP in the oncology department is relatively higher: 9.3 during the day and 34.0 at night. Other departments including internal medicine, surgery, obstetrics and gynaecology, paediatrics, and geriatrics have NTP ratios of 1:7-8 during the day and 1:18-25 at night. CONCLUSIONS: In China, the nurse staffing of large general hospitals has some regional and departmental patterns. The low level of nurse staffing at night may be a problem worthy of attention; the Chinese government needs to establish standards for different periods and departments to improve efficiency and quality of nursing.

Night Admission at a Psychosocial Care Center III / Acogimineto Nocturno en um Centro de Atención Psicosocial III / Acolhimento noturno em um Centro de Atenção Psicossocial III

ABSTRACT Objective: to analyze night admission characteristics at a Psychosocial Care Center III (CAPS III - Centro de Atenção Psicossocial). Method: a qualitative research, whose data were collected with 15 nursing professionals from November to April 2016, through a semi-structured interview. Results: it was verified that night admission is provided by the nursing team in different dynamics from the day care. This team has strategies of care during crisis, avoiding search for other network services and maintaining the CAPS in its function within the psychosocial model. Final considerations: service operation depends on the nursing team for its permanence condition in all shifts, which leads to the need to think about the legislation reformulation that structures the CAPS III team, in order to guarantee the interdisciplinary care provided by the Brazilian Psychiatric Reform in this device, which should replace hospitalization in a specialized institution.

RESUMEN Objetivo: analizar las características de la recepción nocturna de un Centro de Atención Psicosocial III (CAPS III - Centro de Atenção Psicossocial). Método: investigación cualitativa, cuyos datos se recopilaron con 15 profesionales de enfermería, de noviembre a abril de 2016, a través de una entrevista semiestructurada. Resultados: Se verificó que el equipo de enfermería administra el host nocturno en una dinámica diferenciada del anfitrión diurno, y que este equipo tiene estrategias de asistencia durante la crisis, evitando la búsqueda de otros servicios de red y manteniendo el CAPS en su función dentro del modelo psicosocial. Consideraciones finales: el funcionamiento del servicio depende del equipo de enfermería por su condición de permanencia en todos los turnos, lo que lleva a la necesidad de pensar en la reformulación de la legislación que estructura al equipo mínimo de CAPS III, para garantizar la atención interdisciplinaria provista por la Reforma. Psiquiatra brasileño en este dispositivo, que debe reemplazar la hospitalización en una institución especializada.

RESUMO Objetivo: analisar as características do acolhimento noturno de um Centro de Atenção Psicossocial III (CAPS III). Método: pesquisa qualitativa, cujos dados foram coletados com 15 profissionais de enfermagem, de novembro a abril de 2016, por meio de entrevista semiestruturada. Resultados: verificou-se que o acolhimento noturno se dá pela equipe de enfermagem em dinâmica diferenciada do acolhimento diurno, e que esta equipe possui estratégias de atendimento durante a crise, evitando a busca por outros serviços da rede e mantendo o CAPS em sua função dentro do modelo psicossocial. Considerações finais: o funcionamento do serviço depende da equipe de enfermagem pela sua condição de permanência em todos os turnos, o que leva à necessidade de se pensar na reformulação da legislação que estrutura a equipe mínima do CAPS III, de forma a garantir o cuidado interdisciplinar previsto pela Reforma Psiquiátrica brasileira neste dispositivo, que deve substituir a internação em instituição especializada.

Eficacia de un plan de cuidados de enfermería específico para el paciente con delirio / Effectiveness of a Specific Nursing Care Plan for the Patient with Delirium

RESUMEN Introducción: El síndrome confusional agudo o delirio es un trastorno psiquiátrico severo frecuente en pacientes mayores ingresados, tiende a agravarse en las horas del final de la tarde y nocturnas, con un gran impacto en los cuidados nocturnos. Objetivos: Evaluar la eficacia de los cuidados de enfermería específicos ante el delirio nocturno en pacientes hospitalizados. Métodos: Ensayo clínico cuasi-experimental en dos unidades de hospitalización de Medicina Interna de un hospital de alta complejidad. Se identificaron un grupo control y un grupo experimental, mediante muestreo de conveniencia. En ambos grupos, se seleccionaron pacientes con delirio, mediante la escala validada Intensive Care Delirium Screening Checklist. Se expuso al grupo experimental a plan de cuidados específico basado en bibliografía y plan de cuidados estándar al grupo control. Sobre resultados de indicadores de delirio, pre y posaplicación de planes de cuidados en ambos grupos, se realizaron pruebas de contraste (ANOVA, t-Student y Chi2-test de Fisher). Resultados: Con incidencia de 12-15 por ciento, los grupos control y experimental mostraron resultados homogéneos en el test del delirio PRE (p > 0,05). La edad, motivo de ingreso, género, y número de interrupciones durante el sueño, no mostraron repercusión sobre los resultados de delirio. Tras la aplicación de los planes de cuidados, el grupo experimental mostró reducción significativa de los índices de delirio (p < 0,05), y no se obtuvieron cambios significativos en el grupo control (p > 0,05). Conclusiones: El plan de cuidados específico a pacientes con delirio demostró ser eficaz al mejorar los indicadores del test de delirio y evitar el empeoramiento del cuadro(AU)

ABSTRACT Introduction: Acute confusional syndrome or delirium is a severe psychiatric disorder of frequent presentation in hospitalized elderly patients. It worsens likely in the late afternoon and evening hours, with a great impact on night care. Objectives: To evaluate the effectiveness of specific nursing care for sundown delirium in hospitalized patients. Methods: Quasi-experimental clinical trial in two hospitalization units of internal medicine of a high-complexity hospital. A control group and an experimental group were identified by convenience sampling. In both groups, patients with delirium were selected, using the validated scale Intensive Care Delirium Screening Checklist. The experimental group was exposed to a specific care plan, considering the bibliography; and the control group was exposed to a standard care plan. Regarding the results of delirium indicators, before and after the application of the care plans in both groups, contrast tests were performed (ANOVA, t-Student and Fisher's Chi-square test). Results: With an incidence of 12-15 percent, the control and experimental groups showed homogeneous results in the delirium test PRE (p >0.05). Age, reason for admission, gender, and number of interruptions during sleep did not show repercussion on delirium results. After the application of the care plans, the experimental group showed a significant reduction in delirium rates (p < 0.05), and no significant changes were obtained in the control group (p >0.05). Conclusions: The specific care plan for patients with delirium was shown to be effective in improving the indicators of the delirium test and avoiding the worsening of the health status(AU)

Clínica odontológica infanto-juvenil no período noturno: percepções e satisfação dos acompanhantes / Children's evening dental clinic: perceptions and satisfaction of caretakers

Com o início do atendimento na Clínica Odontológica Infanto-juvenil no período noturno na Faculdade de Odontologia da UFRGS, tornou-se necessário avaliar a percepção dos acompanhantes/responsáveis pelas crianças quanto ao horário de atendimento, pontuando questões que poderiam influenciar na vinda dos pacientes para a consulta, tais como segurança, mobilidade e acesso; o padrão comportamental da criança em relação à consulta e no dia posterior ao atendimento; a escolaridade e renda familiar; assim como a razão da busca pelo atendimento odontológico noturno. Foi realizado estudo transversal, observacional e analítico, por meio de questionário. Foram obtidas respostas de 58 acompanhantes, na maioria dos casos a mãe do paciente (60,34%), residindo no mesmo município da instituição (56,90%), com ensino médio completo (37,93%), renda familiar de até 2 salários mínimos (41,38%) e usuários de transporte público (58,62%) para ir e voltar das consultas. Dor e prevenção foram os principais motivos da busca por atendimento. Foram verificadas associações estatisticamente significativas entre responder excelente ou bom para o horário de atendimento e avaliar a qualidade do atendimento como excelente ou boa (p=0,05); informar que o horário não é desgastante para a criança (p=0,01); que a criança não demora para dormir após a consulta (p=0,02); e nunca ter faltado a consultas (p=0,02). A percepção dos acompanhantes foi que a falta de segurança e o congestionamento do tráfego característico do horário de início da consulta foram barreiras enfrentadas para comparecimento. Os acompanhantes apresentaram-se satisfeitos como atendimento noturno e sua percepção foi de que este horário não afetou o padrão comportamental das crianças (AU).

With the start of care at the Children's Evening Dental Clinic in the Dental School of UFRGS, it became necessary to evaluate the perception of children's caretakers regarding the scheduling time, indicating aspects that might influence the patients' arrival for consultation, such as safety, mobility and access; the child behavior in the consultation and the day after care; educational level and family income; as well as the reason to search for evening dental care. A cross-sectional, observational and analytical study was conducted using a questionnaire. Responses were obtained from 58 caretakers, mostly patients' mothers (60.34%), living in the same city of the institution (56.90%), with complete high school education (37.93%), family income up to 2 minimum wages (41.38%) and using public transportation (58.62%) to go back and forth from the consultations. Pain and prevention were the main reasons for seeking care. Statistically significant associations were found between excellent or good response to the scheduling time and evaluating the quality of care as excellent or good (p=0.05); informing that the schedule was not tiring for the child (p=0.01); that the child did not delay to sleep after the consultation (p=0.02); and never missing consultations (p=0.02). The caretakers' perception was that the lack of safety and the jammed traffic characteristic of the time of onset of consultation were barriers faced for attendance. The caretakers were satisfied with the evening attendance and their perception was that this schedule did not affect the child behavior (AU).

Effect of nursing project management on the improvement of night nursing safety / 中国实用护理杂志

Objective To explore the effect of nursing project management on the improvement of night nursing safety quality. Methods Totally 332 cases of inpatients from department of cardiovascular medicine, in accordance with the fore-and-aft sequence of implementing nursing project management, divided into experimental group (160 cases) and control group (172 cases). Through the nursing project improvement management, analyzing the reason of high incidence of adverse events related with the nursing safety at night in control group. Formulating standardized solutions to improve the quality of nursing safety at night. To compare the incidence of night nursing safety incidents, nursing defects and the prevention of nursing defects of the two groups before and after intervention. Results Experimental night nursing safety of nursing adverse events, gaps and prevent nursing defects were occurred in the experimental group 8.75％ (14/160), 10.00％ (16/160), 3.12％ (5/160), the control group after the interventionwere 1.74％ (3/172), 2.33％ (4/172), 11.04％ (19/172), the difference was statistically significant (χ2=6.904, 9.981, 10.626,P< 0.01). After the intervention, patients' self-management ability was enhanced, the experimental group patient compliance, psychological emotion, safety consciousness, rational drug use rate was 56.25％(90/160),52.50％(84/160), 62.50％(100/160), 67.88％(107/160), the control group 86.63％(149/172), 74.41％(128/172), 91.28％(157/172), 88.37％(152/172), the difference was statistically significant (χ2= 4.656- 10.756, P<0.01 or 0.05). Conclusion Nursing project management can effectively improve the quality of night nursing safety and self-management of patients, reduce the occurrence of nursing defects, and improve the safety of nightcare.

[Intervention to reduce the impact of light and noise on sleep in an emergency department observation area]. / Intervención para reducir la repercusión en el sueño de la luz y el ruido en áreas de observación de urgencias.

OBJECTIVES: To study quality of patient rest before and after an intervention to reduce nighttime light and noise in the emergency department observation area of an urban hospital. MATERIAL AND METHODS: Quasi-experimental study in 2 groups before and after the intervention in the observation area of the Hospital Clínic de Barcelona. We administered a questionnaire about the quality of nighttime rest to assess the effect of light and noise on sleep. Light and noise were reduced by means of structural changes to the environment and through the introduction of protocols to modify how care plans were carried out at night. RESULTS: Fifty nurses participated in the pre-intervention study and 371 in the post-intervention study. Seventy-two percent and 91.37% of the patients reported resting well before and after the intervention, respectively (P< .001). Factors like pain, nursing care, or daytime naps do not affect sleep quality. CONCLUSION: Nighttime rest in emergency department observation areas is affected by ambient light and noise more than by other variables. Reducing light and noise at night can measurably improve patients' rest.

OBJETIVO: Conocer la calidad del descanso nocturno tras una intervención para minimizar la presencia de luz y el ruido nocturnos en las áreas de observación de urgencias (AOU) de un hospital urbano. METODO: Se realiza un ensayo clínico cuasiexperimental con un grupo preintervención (Grupo PRE) y otro posterior (Grupo POS) a la intervención, mediante cuestionario ad hoc sobre repercusión de luz y ruido en la calidad del descanso nocturno en el AOU del Hospital Clínic de Barcelona. La intervención consistió en cambios estructurales para reducir luz y el ruido ambientales, así como la instauración de un procedimiento normalizado de trabajo para modificar los planes de cuidados nocturnos. RESULTADOS: Se incluyeron en el Grupo PRE 50 enfermos y 371 en el Grupo POS. El grupo PRE declaró haber tenido un buen descanso en un 72% de los casos frente al 91% del grupo POS (p < 0,001). Factores como el dolor, las intervenciones enfermeras o el sueño diurno no repercutieron en la calidad del sueño. CONCLUSIONES: La luz y el ruido ambientales influyen en el descanso nocturno en AOU más que otras variables conocidas. Intervenciones sobre la luz y el ruido pueden mejorar objetivamente el descanso nocturno de los pacientes.

After-hours care models in leading countries

After-hours care (AHC) provides medical care after the regular weekday work hours of clinics. In Korea, data from the National Emergency Department Information System showed that approximately 40% of the pediatric patients need AHC. To meet this need, many countries have different models of AHC. In this article, the authors tried to summarize and emphasize the advantages and disadvantages of AHC models in several leading countries. This article can be useful in designing AHC models in Korea because the proportions of potential patients requiring AHC are substantial, and the adoption of AHC models should be seriously considered.

Non-emergency department models for pediatric after-hours care

After-hours care (AHC) provides urgent primary care at nighttime, weekends, and holidays. In Korea, individual primary care physicians seldom participate in AHC and many parents have difficulty in receiving primary care during non-office hours without going to an emergency department (ED). The ED is currently the only place to access a full range of services at any time. However, the ED is not optimized for AHC, and using it for AHC is not an efficient use of resources. Therefore, many countries are seeking a safe, efficient non-ED AHC model which provides the best care considering the limitations. Different models for AHC exist worldwide, varying from family doctor-based to hospital-based models, and some countries use several different models including 24-hr telephone triage and advice services (TTA). Common problems of AHC include the inaccessibility to primary care, discontinuity of care, expensive healthcare costs, and work dissatisfaction among health care professionals. These are the major reasons for the recent changes made to the AHC system in many countries, such as the integration into one single national TTA in the United Kingdom, support for group practices in Canada, reorganization of small practice rotation groups into large scaled, general practitioner cooperatives in the Netherlands, and rapid expansion of the urgent care industry in the United States. This review presents a brief overview of the current AHC in Korea and the need for an effective non-ED AHC model. An effective AHC system will improve the quality of care, financial saving, and job satisfaction of the health care professionals.

Clinical Study of Hospital Mortality in Patients Visiting the Emergency Room at Nighttime in a City of Korea

PURPOSE: Attention has been focused recently on the impact of sleep deprivation, in-house staff, and overwork on patient outcome. The objective of this study was to determine whether any associations existed between the timing of a patient visit to an emergency setting and hospital mortality. METHOD: We analyzed retrospectively a series of consecutive visits to the emergency room of our hospital in 2003. Patients were divided according to the times of their visits to emergency room daytime (from 8:00 am to 6:00 pm) and nighttime (all others). We further divided nighttime visits into early nighttime (from 6:00 pm to 1:00 am) and late nighttime (from 1:00 am to 8:00 am) visits. The odds of death within 48 hours after visit for patients in the nighttime group were analyzed by using a multivariate logistic regression. The independent variable was visit to the emergency room during nighttime. RESULT: The patients visiting at night had a lower mortality (0.9% vs 1.6%, p=0.000), with an odd ratio for death within 48 hours, adjusted for severity of illness, of 1.265 (95% CI, 0.955-1.674). Severity of illness was the main contributor to the increased mortality rates of patients in the nighttime group. There was no significant difference in mortality rates between the early and the late nighttime subgroups. CONCLUSION: Nighttime visits to the emergency room are not associated with a higher mortality than daytime visits.