Table 1

Variation in adherence to clinical guidelines in early care by day of week and time of day of admission

Day of week of admissionDifference in adherence
p Value
Monday–Friday 09:00–17:00Monday–Thursday
00:00–08:59
17:01–23:59
Friday 17:01–23:59
Saturday 00:00–23:59
Sunday 00:00–23:59
Difference in adherence p value
MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Seen by any specialty trainee/SpR (ST3+)62%
1374/2208
62%
1204/1928
60%
1068/1767
63%
1077/1714
62%
1020/1641
64%
1040/1627
62%
1087/1767
0.5461%
2502/4111
63%
2877/4592
63%
2491/3949
0.09
Median (IQR) hours*6.8 (2.1–30)5.1 (1.7–22)5.6 (1.8–2.6)5.2 (2.0–25)5.2 (2.0–31)5.0 (1.8–27)5.6 (2.1–25)0.046.3 (2.0–27)5.1 (1.7–24)5.2 (2.1–27)<0.001
If seen, was seen ≤4 hours38%
431/1146
45%
444/983
42%
381/907
42%
384/914
43%
359/839
45%
388/872
41%
367/905
0.0140%
836/2094
44%
1047/2396
42%
871/2076
0.04
Arterial blood gas performed76%
1781/2343
78%
1621/2073
79%
1475/1868
78%
1420/1811
77%
1321/1721
81%
1391/1720
80%
1508/1878
0.00277%
3372/4385
79%
3816/4849
80%
3329/4180
0.007
Second gas taken if first pH <7.3584%
308/368
85%
296/350
86%
276/322
84%
255/304
84%
218/260
85%
287/338
88%
303/344
0.7084%
542/643
84%
743/880
86%
658/763
0.50
No chest X-ray3.8%
89/2343
3.8%
78/2073
4.1%
76/1868
4.4%
79/1811
3.8%
66/1721
3.8%
66/1720
2.3%
43/1878
0.033.9%
172/4385
4.1%
197/4849
3.1%
128/4180
0.03
Chest X-ray within 4 hours of admission82%
1537/1867
86%
1457/1703
86%
1328/1540
85%
1255/1482
83%
1151/1386
88%
1267/1435
87%
1355/1551
<0.00184%
2999/3554
85%
3359/3961
87%
2992/3449
0.01
No ECG7.6%
177/2343
7.2%
149/2073
6.4%
120/1868
6.9%
125/1811
8.1%
140/1721
5.4%
93/1720
6.4%
120/1878
0.048.1%
353/4385
6.4%
311/4849
6.2%
260/4180
0.001
Oxygen prescribed on medication chart/equivalent56%
1317/2343
56%
1155/2073
54%
1017/1868
55%
999/1811
54%
928/1721
57%
977/1720
55%
1041/1878
0.6354%
2373/4385
56%
2716/4849
56%
2345/4180
0.11
First dose of antibiotic within 24 hours86%
2015/2343
86%
1784/2073
85%
1597/1868
86%
1561/1811
86%
1479/1721
86%
1480/1720
86%
1613/1878
0.9985%
3719/4385
87%
4212/4849
86%
3598/4180
0.02
First dose of oral/intravenous steroid within 24 hours89%
2080/2343
87%
1798/2073
88%
1641/1868
88%
1598/1811
88%
1506/1721
88%
1507/1720
89%
1669/1878
0.3686%
3778/4385
89%
4338/4849
88%
3683/4180
<0.001
Given NIV11.9%
279/2343
11.7%
242/2073
10.4%
195/1868
13.0%
236/1811
10.8%
186/1721
12.7%
218/1720
13.6%
256/1878
0.0311.3%
494/4385
12.2%
593/4849
12.6%
525/4180
0.16
Given NIV within 3 hours40%
81/202
38%
68/177
44%
61/138
40%
70/176
46%
66/142
42%
68/161
47%
91/195
0.5837%
133/364
45%
195/430
45%
177/397
0.02
Given NIV if first pH <7.3551%
189/368
52%
181/350
46%
149/322
51%
156/304
48%
125/260
48%
161/338
56%
192/344
0.2252%
335/643
49%
429/880
51%
389/763
0.41
Given NIV if first and second pH <7.3573%
161/220
74%
152/205
66%
112/171
72%
123/172
67%
104/155
69%
131/191
74%
153/208
0.3972%
281/390
71%
340/482
70%
315/450
0.80
Given NIV if first pH ≥7.355.9%
81/1365
4.6%
58/1250
3.7%
42/1122
6.6%
72/1094
4.7%
49/1034
4.9%
50/1029
5.3%
60/1135
0.065.4%
145/2674
5.1%
146/2854
4.8%
121/2501
0.64
Given NIV if first and second pH ≥7.3510.8%
37/344
7.5%
23/305
6.2%
18/290
11.0%
32/290
6.5%
18/277
8.0%
20/251
11.3%
34/302
0.109.6%
68/707
7.9%
56/710
9.0%
58/642
0.51
Decision on ceiling of care (including CPR) documented in notes within 24 hours of admission28%
647/2343
28%
578/2073
28%
516/1868
29%
526/1811
28%
475/1721
29%
498/1720
27%
501/1878
0.7128%
1222/4385
28%
1367/4849
28%
1152/4180
0.80
  • *p Values from Kruskal-Wallis test; otherwise χ2 test.

  • CPR, cardio pulmonary resuscitation; NIV, non-invasive ventilation; SpR, specialist registrar; ST3+, specialty trainee year 3 or more.