ArticleProceedings of the National Academy of Sciences of the United States of America2019
A large-scale study reveals 24-h operational rhythms in hospital treatment.
Article in Proceedings of the National Academy of Sciences of the United States of America, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Challenges and Recommendations for Integrating Circadian Medicine in Critical Care: A Roadmap.Chest · 2026Guideline
- Effectiveness of combined versus single circadian interventions in neonatal and pediatric intensive care units: a systematic review with meta-analysis.Frontiers in neurologyPooled it
- Translational applications of circadian research: connecting chronobiology to medicine.Npj biological timing and sleep · 2026Review
- Article
- Circadian Rhythms, Immune Regulation, and the Risk for Sepsis: Circadian Rhythms and Neonatal Care.Clinics in perinatology · 2025Review
- Circadian gating: concepts, processes, and opportunities.Philosophical transactions of the Royal Society of London. Series B, Biological sciences · 2025Review
- Circadian rhythms in cardiovascular (dys)function: approaches for future therapeutics.NPJ cardiovascular health · 2024Review
- One Health: Circadian Medicine Benefits Both Non-human Animals and Humans Alike.Journal of biological rhythms · 2024Review
- Using routinely collected clinical data for circadian medicine: A review of opportunities and challenges.PLOS digital health · 2024Review
- Circadian Mechanisms in Brain Fluid Biology.Circulation research · 2024Review
- Circadian immunity from bench to bedside: a practical guide.The Journal of clinical investigation · 2024Review
- Pressure Building Against the Clock: The Impact of Circadian Misalignment on Blood Pressure.Current hypertension reports · 2024Review
- Editorial: Rising stars in chronobiology 2022.Frontiers in physiology · 2024Article
- Timing of diuretic administration effects on urine volume in hospitalized patients.Frontiers in physiology · 2023Article
- Are We Ready to Implement Circadian Hygiene Interventions and Programs?International journal of environmental research and public health · 2022Article
- Circadian Rhythms, Disease and Chronotherapy.Journal of biological rhythms · 2021Review
- Circadian Biology in Obstructive Sleep Apnea.Diagnostics (Basel, Switzerland) · 2021Review
- Frontiers in Chronobiology: Endogenous Clocks at the Core of Signaling Pathways in Physiology.Frontiers in physiology · 2021Article
- CosinorPy: a python package for cosinor-based rhythmometry.BMC bioinformatics · 2020Article
- An Optimal Time for Treatment-Predicting Circadian Time by Machine Learning and Mathematical Modelling.Cancers · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
Abstract
Hospitals operate 24 h a day, and it is assumed that important clinical decisions occur continuously around the clock. However, many aspects of hospital operation occur at specific times of day, including medical team rounding and shift changes. It is unclear whether this impacts patient care, as no studies have addressed this. We analyzed the daily distribution of ∼500,000 doses of 12 separate drugs in 1,546 inpatients at a major children's hospital in the United States from 2010 to 2017. We tracked both order time (when a care provider places an electronic request for a drug) and dosing time (when the patient receives the drug). Order times were time-of-day-dependent, marked by distinct morning-time surges and overnight lulls. Nearly one-third of all 103,847 orders for treatment were placed between 8:00 AM and 12:00 PM. First doses from each order were also rhythmic but shifted by 2 h. These 24-h rhythms in orders and first doses were remarkably consistent across drugs, diagnosis, and hospital units. This rhythm in hospital medicine coincided with medical team rounding time, not necessarily immediate medical need. Lastly, we show that the clinical response to hydralazine, an acute antihypertensive, is dosing time-dependent and greatest at night, when the fewest doses were administered. The prevailing dogma is that hospital treatment is administered as needed regardless of time of day. Our findings challenge this notion and reveal a potential operational barrier to best clinical care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.