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Expanding What We Know About Off-peak Mortality in Hospitals

Hamilton, Patti PhD, RN; Mathur, Sondip PhD; Gemeinhardt, Gretchen PhD, MBA; Eschiti, Valerie PhD, RN; Campbell, Marie PhD

Journal of Nursing Administration: March 2010 - Volume 40 - Issue 3 - p 124-128
doi: 10.1097/NNA.0b013e3181d0426e

For more than 30 years, a negative "off-peak effect" on patient outcomes has been associated with weekend and/or nighttime hospitalization in more than 25 diagnostic groups. Descriptive studies have verified the presence of this off-peak effect on patient outcomes but have done little to explain its cause. Institutional ethnography is a promising method for describing challenges nurses encounter and deal with on off-peak shifts and for exploring how those challenges arose in institutions designed to avoid such outcomes. The authors discuss their research and suggest a number of steps that nurse administrators might take to enhance their knowledge for handling off-peak challenges in their hospitals.

Authors' Affiliations: Dean of Graduate Studies (Dr Hamilton), Midwestern State University, Wichita Falls, Texas; Assistant Professor (Dr Mathur) College of Pharmacy and Health Sciences, Texas Southern University, Houston; Director, Leadership Institute (Dr Gemeinhardt) Harris County Hospital District, Houston, Texas; Assistant Professor of Nursing (Dr Eschiti) University of Oklahoma; Professor Emeritus (Dr Campbell) University of Victoria, British Columbia, Canada.

Corresponding author: Dr Hamilton, Graduate Studies, Midwestern State University, 3410 Taft, Wichita Falls, TX 76308 (

Funding: Funding for this project was provided by the Robert Wood Johnson Foundation's Interdisciplinary Nursing Quality Research Initiative.

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