WIHI: Night Talks and Nocturnists: New Interventions for the Hospital at Night

Date: December 1, 2011 


  • David Gozzard, FRCP, FRCPath, MBA, Consultant in Quality Improvement, North Wales, UK; Former Consultant Haematologist
  • Christine White, MD, MAT, Assistant Professor, Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center
  • Win Whitcomb, MD, MHM, Medical Director of Healthcare Quality, Baystate Health

Although most hospitals are open for business 24/7, patients are well aware that days, nights, weekends, and holidays are not created equally in hospitals. There’s a history of assigning fewer medical and nursing staff during these times, creating a host of challenges for improvement leaders seeking to ensure safe and reliable care regardless of what the clock says. And there are real consequences: a study published in JAMA in 2008 found that patients who had heart attacks in the hospital at night and on weekends were less likely to survive than if they’d arrested during “normal business hours.”

Innovative solutions to close this gap in care are cropping up in several corners. In the US, the growing number of and reliance on hospitalists is giving rise to a particular type of hospitalist, known as a “nocturnist,” who specializes in after-hours care. In the UK, attention to patient safety as well as work hours for medical staff have spawned an increasingly widespread practice of interdisciplinary “night teams.” And, many hospitals are focusing on night times and weekends as part of their overall efforts to improve handoffs between nursing shifts and medical residents, who, in the US, now have shifts of their own they must adhere to in order to comply with ACGME regulations.

So, the road to ensuring that patients get the same kind of care, no matter the time of day or night, is definitely still under development. Guests Drs. David Gozzard, Christine White, and Win Whitcomb join WIHI host Madge Kaplan to share how they are contributing to the solutions for providing reliable, high-quality care.



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