Dying for the Weekend

Abstract

Patients: Patients during the study period accounted for 93 621 admissions. We used logistic regression to adjust the outcome measures for case mix. Main Outcome Measures: Quality and safety measurements using 6 indicators spanning the hospital care pathway, from timely brain scans to emergency readmissions after discharge. Results: Performance across 5 of the 6 measures was significantly lower on weekends (confidence level, 99%). One of the largest disparities was seen in rates of same-day brain scans, which were 43.1% on weekends compared with 47.6% on weekdays (unadjusted odds ratio, 0.83 [95% CI, 0.81-0.86]). In particular, the rate of 7-day in-hospital mortality for Sunday admissions was 11.0% (adjusted odds ratio, 1.26 [95% CI, 1.16-1.37], with Monday used as a reference) compared with a mean of 8.9% for weekday admissions. Conclusions: Strong evidence suggests that, nationally, stroke patients admitted on weekends are less likely to receive urgent treatments and have worse outcomes across a range of indicators. Although we adjusted the results for case mix, we cannot rule out some of the effect being due to unmeasured differences in patients admitted on weekends compared with weekdays. The findings suggest that approximately 350 in-hospital deaths each year within 7 days are potentially avoidable, and an additional 650 people could be discharged to their usual place of residence within 56 days if the performance seen on weekdays was replicated on weekends.

Incidence of "never events" among weekend admissions versus weekday admissions to US hospitals: national analysis

“…Numerous studies from multiple countries have shown significant increases in mortality (from 3% to 20%) associated with weekend hospital admissions 1819 20 21 41 42 43 This finding was also consistent with our tertiary analysis, indicating that the likelihood of mortality in patients admitted at weekends was 11% higher than that of patients admitted on weekdays (odds ratio 1.11, 95% confidence interval 1.10 to 1.12, P<0.01). However, the frequency of preventable hospital events may actually be a more accurate reflection of overwhelmed medical systems in the weekend environment.…”

Incidence of "never events" among weekend admissions versus weekday admissions to US hospitals: national analysis

“…Numerous studies from multiple countries have shown significant increases in mortality (from 3% to 20%) associated with weekend hospital admissions 1819 20 21 41 42 43 This finding was also consistent with our tertiary analysis, indicating that the likelihood of mortality in patients admitted at weekends was 11% higher than that of patients admitted on weekdays (odds ratio 1.11, 95% confidence interval 1.10 to 1.12, P<0.01). However, the frequency of preventable hospital events may actually be a more accurate reflection of overwhelmed medical systems in the weekend environment.…”

Mortality following Stroke, the Weekend Effect and Related Factors: Record Linkage Study

“…The increased mortality for weekend admissions of 19% at seven days is very similar to a corresponding figure of 18% reported nationally across England during the 12 month period from April 2009 to March 2010 [ 6 ] and our increased weekend mortality of 16% at 30 days is also similar to 14% reported from the 130 hospitals across England included in a recent national audit from 2010 to 2012 [ 9 ].…”

Weekday and Survival After Cardiac Surgery—A Swedish Nationwide Cohort Study in 106 473 Patients

“…25 The majority of studies in relation to surgical procedures or acute admissions investigating this topic have been conducted using hospital administrative data without detailed information about patient comorbidity or operative risk. [3][4][5]24 Therefore, our study extends the findings from previous research because the role of risk factor profile, urgency, and type of procedure could be accounted for in detail through In Sweden, all patients benefit from universal tax-financed health care, irrespective of employment status and individual financial situation. 15 Insurance status or availability did not influence the indication for surgery.…”

“…The majority of studies in relation to surgical procedures or acute admissions investigating this topic have been conducted using hospital administrative data without detailed information about patient comorbidity or operative risk . Therefore, our study extends the findings from previous research because the role of risk factor profile, urgency, and type of procedure could be accounted for in detail through access to SWEDEHEART and other national Swedish health‐data registers.…”

Incidence of "never events" among weekend admissions versus weekday admissions to US hospitals: national analysis

“…Numerous studies from multiple countries have shown significant increases in mortality (from 3% to 20%) associated with weekend hospital admissions 1819 20 21 41 42 43 This finding was also consistent with our tertiary analysis, indicating that the likelihood of mortality in patients admitted at weekends was 11% higher than that of patients admitted on weekdays (odds ratio 1.11, 95% confidence interval 1.10 to 1.12, P<0.01). However, the frequency of preventable hospital events may actually be a more accurate reflection of overwhelmed medical systems in the weekend environment.…”

Mortality following Stroke, the Weekend Effect and Related Factors: Record Linkage Study

“…The increased mortality for weekend admissions of 19% at seven days is very similar to a corresponding figure of 18% reported nationally across England during the 12 month period from April 2009 to March 2010 [ 6 ] and our increased weekend mortality of 16% at 30 days is also similar to 14% reported from the 130 hospitals across England included in a recent national audit from 2010 to 2012 [ 9 ].…”

Weekday and Survival After Cardiac Surgery—A Swedish Nationwide Cohort Study in 106 473 Patients

“…25 The majority of studies in relation to surgical procedures or acute admissions investigating this topic have been conducted using hospital administrative data without detailed information about patient comorbidity or operative risk. [3][4][5]24 Therefore, our study extends the findings from previous research because the role of risk factor profile, urgency, and type of procedure could be accounted for in detail through In Sweden, all patients benefit from universal tax-financed health care, irrespective of employment status and individual financial situation. 15 Insurance status or availability did not influence the indication for surgery.…”

“…The majority of studies in relation to surgical procedures or acute admissions investigating this topic have been conducted using hospital administrative data without detailed information about patient comorbidity or operative risk . Therefore, our study extends the findings from previous research because the role of risk factor profile, urgency, and type of procedure could be accounted for in detail through access to SWEDEHEART and other national Swedish health‐data registers.…”

Incidence of "never events" among weekend admissions versus weekday admissions to US hospitals: national analysis

“…Numerous studies from multiple countries have shown significant increases in mortality (from 3% to 20%) associated with weekend hospital admissions 1819 20 21 41 42 43 This finding was also consistent with our tertiary analysis, indicating that the likelihood of mortality in patients admitted at weekends was 11% higher than that of patients admitted on weekdays (odds ratio 1.11, 95% confidence interval 1.10 to 1.12, P<0.01). However, the frequency of preventable hospital events may actually be a more accurate reflection of overwhelmed medical systems in the weekend environment.…”

Mortality following Stroke, the Weekend Effect and Related Factors: Record Linkage Study

“…The increased mortality for weekend admissions of 19% at seven days is very similar to a corresponding figure of 18% reported nationally across England during the 12 month period from April 2009 to March 2010 [ 6 ] and our increased weekend mortality of 16% at 30 days is also similar to 14% reported from the 130 hospitals across England included in a recent national audit from 2010 to 2012 [ 9 ].…”

Weekday and Survival After Cardiac Surgery—A Swedish Nationwide Cohort Study in 106 473 Patients

“…25 The majority of studies in relation to surgical procedures or acute admissions investigating this topic have been conducted using hospital administrative data without detailed information about patient comorbidity or operative risk. [3][4][5]24 Therefore, our study extends the findings from previous research because the role of risk factor profile, urgency, and type of procedure could be accounted for in detail through In Sweden, all patients benefit from universal tax-financed health care, irrespective of employment status and individual financial situation. 15 Insurance status or availability did not influence the indication for surgery.…”

“…The majority of studies in relation to surgical procedures or acute admissions investigating this topic have been conducted using hospital administrative data without detailed information about patient comorbidity or operative risk . Therefore, our study extends the findings from previous research because the role of risk factor profile, urgency, and type of procedure could be accounted for in detail through access to SWEDEHEART and other national Swedish health‐data registers.…”