Mortality among emergency medical admissions to hospital is higher for admissions at the weekend than on weekdays; this also holds true for certain specific conditions. However, it is unknown whether that effect is limited to weekends. This study calculated mortality in emergency medical admissions for each day of the week, and compared mortality at weekends with weekdays, at nights with days, and in all out-of-hours periods with in-hours in a UK district general hospital. Total mortality was increased for admissions on Mondays, at night, and in all out-of-hours periods; late in-hospital mortality (after seven days) remained increased when the initial admission occurred on Mondays, at night or out of hours. It is likely that illness severity as well as resource and organisational factors are involved.

Hypernatraemia is a common fi nding among patients presenting to hospital. The aim of this observational study was to discover what types of patients presented with hypernatraemia and whether they were appropriately managed. The management of hypernatraemia was audited against common standards of care. Hypernatraemia at presentation carries a poor prognosis and in this study management of hypernatraemia was found to be done poorly, possibly because for many patients aggressive management was deemed inappropriate. The majority of patients who present with hypernatraemia are older, dependent and/or suffer from cognitive impairment. Many of these patients do not have a reversible cause for their hypernatraemia. These patients need to be recognised, ideally in the community, so that inappropriate admission can be avoided, but also on presentation to hospital so that appropriate care, which may be end-of-life care, can be provided.

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Risk of first venous thromboembolism in pregnant women in hospital: population based cohort study from England.