Life Is All about Timing: An Examination of Differences in Treatment Quality for Trauma Patients Based on Hospital Arrival Time



In health care, most quality transparency and improvement programs focus on the quality variation across hospitals, while we know much less about within-hospital quality variation. This study examines one important factor that is associated with the fluctuation of quality of care in the same hospital—the timing of patient arrival. We analyze data from the National Trauma Data Bank and find that patients arriving at the hospital during off-hours (6 PM–6 AM) receive significantly lower quality care than those who arrive during the daytime, as reflected in higher mortality rates, among other measures. More importantly, we try to uncover the mechanism for the quality variation. Interestingly, we find consistent evidence that the inferior care received during off-hours is not likely due to unobserved heterogeneity, disruptions in circadian rhythms, or delays in receiving treatment. Instead, it is more likely due to the limited availability of high-quality resources. This leads to a higher surgical complication rate, a higher likelihood of multiple surgeries, and longer patient length of stay in the intensive care unit. These findings have important implications for optimal resource allocation in hospitals to improve the quality-of-care delivery.