Two Standards of Sepsis Care – The Nighttime Effect


  • Services in most hospitals differ between day & night or weekend shifts.
  • With clinical staff and hospital resources typically diminished during “off hours”, there is increased risk of varying diagnosis, treatments and outcomes of various time sensitive conditions.
  • Limited data indicates, sepsis is no exception to the “Nighttime Effect”.


  • The largest study on the Nighttime effect was recently published (Ranzani et al Ann Am Thorac Soc 2020;17:980-987).
  • 10 private hospitals in Sao Paulo Brazil from 2010-2017
  • 11,737 sepsis patients
    • 8,733 severe sepsis/3,004 septic shock
    • Adjusted for case mix
  • Daytime: 0700 – 1859/Nighttime 1900 – 0659
  • Weekends Friday 1900 to Monday 0659


  • Patients treated during daytime hours had more frequent:
    • Lactate Measurement
    • Early antibiotic administration


  • The adjusted Odds Ratio showed a difference between Day vs Night outcomes but not weekday vs weekend outcomes.
  • The gap between day vs night patient 3-hour bundle completion widened over the study period.
  • In comparison, a recent study (You et al Critical Care 2022;26:43) in 2,000 septic shock patients showed improved timely antibiotic administration during nighttime vs daytime, with a significantly lower staffing ratio at nighttime.
  • They also had higher completion of the 3-hour bundle, although other individual components were not different between the groups.


  • Early recognition and management of sepsis is key to improving outcomes.
  • The impact of off hours admissions on various disease states is well studies in terms of diagnosis, treatment and clinical outcomes.
  • Limited data in patients within the emergency department indicate they are also subject to “The Nighttime Effect” of limited resources and potentially less experienced staff.
  • Septic shock patients may be the exception as this condition is more easily recognizable as compared to sepsis without shock.

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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (, or video chat.