Abstract 2836: Emergency Department Nursing Shift Change and Adverse Outcomes in Patients with Intracranial Hemorrhage
Introduction: Extended time in the emergency department (ED) has been related to adverse outcomes among stroke patients. Previous research reported higher rates of pneumonia and poorer outcomes in ischemic stroke patients present during an emergency department nursing shift change (SC). We examined the association between SC and adverse outcomes in patients with intracerebral hemorrhage (ICH).
Methods: Data were collected on all spontaneous ICH patients admitted to Tulane Medical Center from 7/1/08-12/31/10. Records were reviewed for pertinent times, demographics, and clinical variables. Baseline characteristics were evaluated using Chi-square and t-tests with non-parametric methods used when appropriate. Outcomes were compared between patients experiencing an ED SC and those that did not experience SC. Frequency of pneumonia, modified Rankin Scale (mRS) score at discharge, NIHSS score at discharge, and mortality rate were examined using linear regression, logistic regression, and cumulative logit models adjusting for potential confounding variables.
Results: Of the 110 patients, 41(36.9%) were present in the ED during a SC. Patient demographics and clinical data are provided in Table 1. The frequency of pneumonia was similar in the two groups. Exposure to an ED SC was not a significant independent predictor of discharge mRS (p=0.75), discharge NIHSS (p=0.49), or mortality (OR 1.24, 95% CI 0.41-3.77, p =0.70). Length of stay in the ED dichotomized into <5 hours and ≥5 hours was not a significant independent predictor of death (OR=0.590, 95%CI 0.201-1.733, p=0.337), discharge mRS (OR=0.566, 95%CI 0.263-1.218, p=0.1456) or discharge NIHSS (OR=0.602, 95%CI0.128-1.966, p=0.4003).
Discussion: Our study found no association between nursing SC and adverse outcome in patients with ICH. We speculate that our findings in ICH differ from findings in ischemic stroke due to head of bed positioning recommended for each type of stroke.
- © 2012 by American Heart Association, Inc.