The witching time: diurnal patterns in adverse events of clinical management

Abstract

Purpose

The objective of this study is to investigate the existence of a diurnal pattern in the occurrence of adverse clinical management events.

Design/methodology/approach

The approach takes the form of a retrospective record review of adverse clinical management events occurring in the 63 facilities of a statutory public health provider in rural south‐eastern Australia. Between January 2006 and December 2007, 2,463 clinical management incidents were reported by clinical staff to a specially designed database.

Findings

Adverse clinical management incidents exhibit a marked diurnal pattern. This pattern was evident in both medicine and surgery as well as across facilities of differing acuity. The acrophase or peak of the daily cycle occurs at 14:30 hrs (95%CI 13:25 and 15:34 hrs). Although surgical events peaked earlier in the day (14.02hrs: 95%CI 12:32‐15:32) compared with medicine events (15:26hrs: 95%CI 13:07‐15:32), this difference was not statistically significant.

Research limitations/implications

As the activity rate in the hospital is unknown, this finding study reports the time of the day when most adverse events occur and not their rate as a function of procedural volume.

Practical implications

The existence of a diurnal pattern provides valuable information for strategies aimed at improving patient safety and health care quality. Interventions can now be more accurately targeted.

Originality/value

The paper is the first to move beyond descriptive data of the timing of adverse events and offers a model using chronobiological methods. The demonstration of the existence of diurnal patterns should improve programmes to reduce adverse events.

Citation

Buckley, D., Reyment, J. and Curtis, P. (2009), "The witching time: diurnal patterns in adverse events of clinical management", Clinical Governance: An International Journal, Vol. 14 No. 4, pp. 281-288. https://doi.org/10.1108/14777270911007791