Wenn andere schlafen – Leistungsfähigkeit der Patientenversorgung in der Nacht am Beispiel der Schwerverletztenversorgung

Introduction: The literature indicates that medical staff suffer from a decline in cognitive and physical performance at night. This study evaluates the process quality and outcomes of emergency care during night-time and daytime. Method: Out of 1,226 prospectively registered patients, 420 were included into this study (observation period: 76 months). Inclusion criteria were an ISS >= 16 and admission to trauma room during "DAY" (8 am to 4: 49 pm) or "NIGHT" (9pm to 5: 59 am). The fundamental part was the 130 items of the TraumaRegister DGU. The additional 350 items contain data about prehospital treatment, trauma room management and intensive care. Data were collected by a research assistant over a 24-h period. Results: The study sample contained 268 DAY-patients and 152 NIGHT-patients. Patients admitted during night were injured more severely: ISS 34.9 (+/- 16.4) vs. 31.1 (+/- 14.2), p = 0.015 and younger: 33.3 (+/- 16.6) vs. 43.6 (+/- 22.3) years old, p = 0.775. Furthermore, no difference in process quality was observed like the time to gain an arterial access: NIGHT 4.5 (+/- 3.7) vs. DAY 5.0 (+/- 3.7) min, p = 0.116, time for splinting 3.8 (+/- 3.7) vs. 3.4 (+/- 3.1) min, p = 0.922, or other parameters, like time to CT: 26.9 (+/- 11.2) vs. 26.6 (+/- 14.5) min, p = 0.520. Nor was there any difference in outcome: 17.8% of the NIGHT-patients (RISC-prognosis: 23.8%, SMR 0.74) died in hospital, and 18.3% of the DAY-patients (RISC-prognosis: 24.0%, SMR 0.77), p = 0.894. As well the comparison of the Glasgow Outcome Scale revealed no difference: NIGHT 3.8 (+/- 1.5) vs. DAY 3.8 (+/- 1.6), p = 0.491. Discussion: Although evidence suggests a drop of performance by medical staff at night, this effect could not be demonstrated. Considering this, the level of process quality and outcome - regardless of the time of arrival - remained constant on a high level. These results might be attributable to the quality management and the standardisation of the treatment