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A large-scale study reveals 24-h operational rhythms in hospital treatment

Hospitals operate 24 h a day, and it is assumed that important clinical decisions occur continuously around the clock. However, many aspects of hospital operation occur at specific times of day, including medical team rounding and shift changes. It is unclear whether this impacts patient care, as no...

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Autores principales: Ruben, Marc D., Francey, Lauren J., Guo, Yuping, Wu, Gang, Cooper, Edward B., Shah, Amy S., Hogenesch, John B., Smith, David F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: National Academy of Sciences 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800314/
https://www.ncbi.nlm.nih.gov/pubmed/31575744
http://dx.doi.org/10.1073/pnas.1909557116
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author Ruben, Marc D.
Francey, Lauren J.
Guo, Yuping
Wu, Gang
Cooper, Edward B.
Shah, Amy S.
Hogenesch, John B.
Smith, David F.
author_facet Ruben, Marc D.
Francey, Lauren J.
Guo, Yuping
Wu, Gang
Cooper, Edward B.
Shah, Amy S.
Hogenesch, John B.
Smith, David F.
author_sort Ruben, Marc D.
collection PubMed
description Hospitals operate 24 h a day, and it is assumed that important clinical decisions occur continuously around the clock. However, many aspects of hospital operation occur at specific times of day, including medical team rounding and shift changes. It is unclear whether this impacts patient care, as no studies have addressed this. We analyzed the daily distribution of ∼500,000 doses of 12 separate drugs in 1,546 inpatients at a major children’s hospital in the United States from 2010 to 2017. We tracked both order time (when a care provider places an electronic request for a drug) and dosing time (when the patient receives the drug). Order times were time-of-day−dependent, marked by distinct morning-time surges and overnight lulls. Nearly one-third of all 103,847 orders for treatment were placed between 8:00 AM and 12:00 PM. First doses from each order were also rhythmic but shifted by 2 h. These 24-h rhythms in orders and first doses were remarkably consistent across drugs, diagnosis, and hospital units. This rhythm in hospital medicine coincided with medical team rounding time, not necessarily immediate medical need. Lastly, we show that the clinical response to hydralazine, an acute antihypertensive, is dosing time-dependent and greatest at night, when the fewest doses were administered. The prevailing dogma is that hospital treatment is administered as needed regardless of time of day. Our findings challenge this notion and reveal a potential operational barrier to best clinical care.
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spelling pubmed-68003142019-10-24 A large-scale study reveals 24-h operational rhythms in hospital treatment Ruben, Marc D. Francey, Lauren J. Guo, Yuping Wu, Gang Cooper, Edward B. Shah, Amy S. Hogenesch, John B. Smith, David F. Proc Natl Acad Sci U S A Biological Sciences Hospitals operate 24 h a day, and it is assumed that important clinical decisions occur continuously around the clock. However, many aspects of hospital operation occur at specific times of day, including medical team rounding and shift changes. It is unclear whether this impacts patient care, as no studies have addressed this. We analyzed the daily distribution of ∼500,000 doses of 12 separate drugs in 1,546 inpatients at a major children’s hospital in the United States from 2010 to 2017. We tracked both order time (when a care provider places an electronic request for a drug) and dosing time (when the patient receives the drug). Order times were time-of-day−dependent, marked by distinct morning-time surges and overnight lulls. Nearly one-third of all 103,847 orders for treatment were placed between 8:00 AM and 12:00 PM. First doses from each order were also rhythmic but shifted by 2 h. These 24-h rhythms in orders and first doses were remarkably consistent across drugs, diagnosis, and hospital units. This rhythm in hospital medicine coincided with medical team rounding time, not necessarily immediate medical need. Lastly, we show that the clinical response to hydralazine, an acute antihypertensive, is dosing time-dependent and greatest at night, when the fewest doses were administered. The prevailing dogma is that hospital treatment is administered as needed regardless of time of day. Our findings challenge this notion and reveal a potential operational barrier to best clinical care. National Academy of Sciences 2019-10-15 2019-10-01 /pmc/articles/PMC6800314/ /pubmed/31575744 http://dx.doi.org/10.1073/pnas.1909557116 Text en Copyright © 2019 the Author(s). Published by PNAS. https://creativecommons.org/licenses/by-nc-nd/4.0/ https://creativecommons.org/licenses/by-nc-nd/4.0/This open access article is distributed under Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Biological Sciences
Ruben, Marc D.
Francey, Lauren J.
Guo, Yuping
Wu, Gang
Cooper, Edward B.
Shah, Amy S.
Hogenesch, John B.
Smith, David F.
A large-scale study reveals 24-h operational rhythms in hospital treatment
title A large-scale study reveals 24-h operational rhythms in hospital treatment
title_full A large-scale study reveals 24-h operational rhythms in hospital treatment
title_fullStr A large-scale study reveals 24-h operational rhythms in hospital treatment
title_full_unstemmed A large-scale study reveals 24-h operational rhythms in hospital treatment
title_short A large-scale study reveals 24-h operational rhythms in hospital treatment
title_sort large-scale study reveals 24-h operational rhythms in hospital treatment
topic Biological Sciences
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6800314/
https://www.ncbi.nlm.nih.gov/pubmed/31575744
http://dx.doi.org/10.1073/pnas.1909557116
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