For a study, researchers sought to evaluate patients’ presentations to the emergency department (ED) during the night on their outcomes after being admitted with severe upper gastrointestinal hemorrhage (UGIH). Investigators categorized adults hospitalized for UGIH into daytime (07:00 to 18:59 h) and night-time (19:00 to 06:59 h) categories based on the time of ED presentation. This was done using the 2016 and 2017 Florida State Inpatient Databases. They compared the clinical outcomes of both groups, which included all-cause in-hospital mortality, in-hospital endoscope utilization, length of stay (LOS), total hospitalization expenses, and 30-day all-cause readmission rates. Propensity scores matched the 2 groups. Results showed that out of the 38,114 patients with UGIH, 89.4% (n=34,068) were diagnosed with acute nonvariceal hemorrhage (ANVH), while 10.6% (n=4,046) were diagnosed with acute variceal hemorrhage (AVH). ANVH patients admitted at night had higher odds of in-hospital mortality (odds ratio: 1.32; 95% CI: 1.06-1.60), lower odds of in-patient endoscopy (odds ratio: 0.83; 95% CI: 0.77-0.90), and higher total hospital costs ($9,911 vs $9,545, P<0.016). However, the LOS and readmission rates were comparable for both groups. Patients admitted to the hospital at night for AVH had a lower LOS (5.4 days compared to 5.8 days, P=0.045). Still, they had comparable mortality rates, endoscopic use, total hospitalization expenses, and readmission rates. Compared with daytime patients, those who presented to the emergency department (ED) with symptoms of ANVH during the night-time had significantly poorer results in terms of mortality, expenses associated with hospitalization, and endoscopy utilization. However, individuals with AVH had equivalent outcomes regardless of when they arrived at the ED.

SOURCE – journals.lww.com/jcge/Abstract/2022/08000/The_Impact_of_Night_time_Emergency_Department.6.aspx