Abstract
Objective: To determine whether the higher weekend admission mortality risk is attributable to increased severity of illness.
Design: Retrospective analysis of 4 years weekend and weekday adult emergency admissions to a university teaching hospital in England.
Outcome Measures: 30-day post-admission weekend:weekday mortality ratios adjusted for severity of illness (baseline National Early Warning Score), routes of admission to hospital, transfer to the Intensive Care Unit (ICU), and demographics.
Results: Despite similar emergency department (ED) daily attendance rates, fewer patients were admitted at weekends (mean admission rate 91/d vs 120/d), because of fewer general practitioner referrals. Weekend admissions were sicker than weekday (mean NEWS 1.8 vs 1.7, p=0.008), more likely to undergo transfer to ICU within 24h (4.2%; 3.8/d versus 3.0%; 3.6/d), spent longer in hospital (median 3d vs 2d), and less likely to experience same day discharge (17.2% vs 21.9%) (all p values <0.001).
The crude 30-day post-admission mortality ratio for weekend admission (OR=1.13; CI 1.08-1.19) was attenuated using standard adjustment (OR=1.11; CI 1.05-1.17). In patients for whom NEWS values were available (90%), the crude OR (1.07; CI 1.01-1.14) was not affected with standard adjustment. Adjustment using NEWS alone nullified the weekend effect(OR=1.02; 0.96-1.08).
NEWS completion rates were higher at weekends (91.7%) than weekdays (89.5%). Missing NEWS was associated with direct transfer to intensive care bypassing electronic data capture. Missing NEWS in non-ICU weekend patients was associated with a higher mortality and fewer same-day discharges than weekdays.
Conclusions: Patients admitted to hospital at weekends are sicker than those admitted on weekdays. The cause of the weekend effect may lie in community services.
Design: Retrospective analysis of 4 years weekend and weekday adult emergency admissions to a university teaching hospital in England.
Outcome Measures: 30-day post-admission weekend:weekday mortality ratios adjusted for severity of illness (baseline National Early Warning Score), routes of admission to hospital, transfer to the Intensive Care Unit (ICU), and demographics.
Results: Despite similar emergency department (ED) daily attendance rates, fewer patients were admitted at weekends (mean admission rate 91/d vs 120/d), because of fewer general practitioner referrals. Weekend admissions were sicker than weekday (mean NEWS 1.8 vs 1.7, p=0.008), more likely to undergo transfer to ICU within 24h (4.2%; 3.8/d versus 3.0%; 3.6/d), spent longer in hospital (median 3d vs 2d), and less likely to experience same day discharge (17.2% vs 21.9%) (all p values <0.001).
The crude 30-day post-admission mortality ratio for weekend admission (OR=1.13; CI 1.08-1.19) was attenuated using standard adjustment (OR=1.11; CI 1.05-1.17). In patients for whom NEWS values were available (90%), the crude OR (1.07; CI 1.01-1.14) was not affected with standard adjustment. Adjustment using NEWS alone nullified the weekend effect(OR=1.02; 0.96-1.08).
NEWS completion rates were higher at weekends (91.7%) than weekdays (89.5%). Missing NEWS was associated with direct transfer to intensive care bypassing electronic data capture. Missing NEWS in non-ICU weekend patients was associated with a higher mortality and fewer same-day discharges than weekdays.
Conclusions: Patients admitted to hospital at weekends are sicker than those admitted on weekdays. The cause of the weekend effect may lie in community services.
Original language | English |
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Number of pages | 8 |
Journal | BMJ Quality & Safety |
Early online date | 9 Oct 2018 |
DOIs | |
Publication status | E-pub ahead of print - 9 Oct 2018 |
Keywords
- mortality (standardized mortality ratios)
- patient safety
- duty hours/work hours
- emergency department
- hospital medicine