12lead_sm.jpgThe question is bound to come up sometime — When is the best time to have your heart attack or cardiac arrest when you are in the hospital (it’s important to plan ahead)?

There was a study a year or so ago that focused on the increased mortality rates for cardiac arrest patients in different facilities (rural, urban, suburban) and on different days of the week. Not surprisingly, the study found that small rural hospitals and most hospitals on weekends had poorer survivability from cardiac arrest.

What about the time of day?  Well someone else thought to ask and that study has now been released. The authors found in their case review that 15% of cardiac arrest in hospitals survived between the hours of 11 PM and 7 AM compared to 20% during the daytime hours.  Again, I’m not terribly surprised.  After hours, staffing ratios fall as many patients are asleep.  Often in small hospitals, the only doctor in the building is in the emergency department after 8 or 9 PM.

Try running a code simultaneously in the ICU at one end of a building and in the ED at the other.  Difficult to do, right?  It’s important to review this information for your facility and determine whether a different set of standing orders needs to be in place for after hours care in the onset of acute emergencies requiring ACLS interventions.

Many med-surg nurses don’t maintain their ACLS certifications (because they’re not required to) or perhaps never got them to begin with. There needs to be a code team in place to handle the onset of multiple cardiac events even in — or perhaps especially in — smaller hospitals so that patient care and survivability can reach its full potential.

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