Effects of weekend admission and hospital teaching status on in-hospital mortality

Cram, Peter; Hillis, Stephen L.; Barnett, Mitchell J.; Rosenthal, Gary E.

doi:10.1016/j.amjmed.2004.02.035

Cited by 321 publications

(258 citation statements)

References 15 publications

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“…7 Factors cited as contributing to this disparity include skeleton medical and nursing coverage, often exacerbated by less experience, supervision, and patient familiarity than their weekday counterparts. 8,9 Limited specialized clinics, complex medical care, inter-professional expertise, and breakdowns in communication further compromise care during these times. 10 …”

Section: Current Situationmentioning

confidence: 99%

Excellent Hospital Care for All: Open and Operating 24/7

Wong

Morra

2011

J GEN INTERN MED

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Nights and weekends are the times when most people are admitted to the hospital. They are also synonymous with reduced staffing levels and fewer specialized diagnostic, procedural, and treatment options. Indeed, there is increasing evidence suggesting that patient care is compromised during these times. Equally important is the inefficient use of capital investments during nights and weekends, and inappropriate utilization of hospital beds caused by poor weekend discharge flexibility. We believe that these findings should be of concern not just to hospital care providers, but across care settings and to the general public. In this perspective article, we highlight how our current office-hours system of running hospitals threatens the lives of our sickest, most vulnerable patients, describe solutions currently implemented in hospitals that may alleviate this disparity, and discuss challenges to wider scale implementation.KEY WORDS: nights and weekend; hospital care; quality and safety; efficiency.

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Section: Current Situationmentioning

confidence: 99%

Excellent Hospital Care for All: Open and Operating 24/7

Wong

Morra

2011

J GEN INTERN MED

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“…As for WE versus WD, although a high mortality in subjects admitted during the WE has been reported by several authors, with an estimated increase of risk between 10% and 32% [14,15,[20][21][22] , in our study there was a trend in which more patients admitted during the WE died than those admitted on WD, but this was not confirmed by multivariate analysis. The results reported in the literature are not always consistent when considering the levels of hospital: the prognostic value of WE admission was identified more frequently in major teaching hospitals compared with nonteaching hospitals [23] , but no correlation between WE admission and IHM was found in patients admitted to tertiary care hospitals [24] .…”

Section: Discussionmentioning

confidence: 80%

In-hospital mortality and length-of-stay in a cohort of ED patients admitted to internistic units

Giorgi¹,

Fabbian²,

Ferro³

et al. 2013

JHA

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Background: Several life-threatening acute diseases exhibit precise preferred times of onset, during the day (morning), the month or season of the year (winter), and the day of the week (Monday). Moreover, admission to the hospital during nighttime and weekend (WE) is associated with increased risk of in-hospital mortality (IHM) and length-of-hospital stay (LOS). Since most of these data have been obtained in North American settings, the aim of this study was to verify also in an Italian setting whether some factors related to ED evaluation, including time of arrival, and disease's severity evaluated by a colour code, could be associated with IHM and LOS in ED patients admitted to internal medicine units. Methods:This study was conducted between January 1, 2010 and July 31, 2012, at the St Anna Hospital of Ferrara. We analyzed age, sex, time of arrival to the ED, ED boarding time, and triage colour code of all patients admitted to the Department of Medicine. Friday to midnight Sunday was considered as WE, and the nine main national festive days were always considered as Sunday-WE. Thus, the time period was classified into holidays (WE + festive days) and weekdays (WD), and daytime (8:00 am -8:00 pm) and nighttime (8:00 pm -8:00 am). IHM and LOS were assumed as primary and secondary objectives, respectively. Patients were classified into deceased and survivors, and LOS was classified depending on length lower or higher than the median (seven days). T-test, chi-squared test, U Mann-Whitney test, and logistic regression analysis were performed.Results: During the 18-month period, 13,237 consecutive patients visiting the ED (43.4% males, mean age 74.8 ± 13.6 years, 56.6% females, mean age 78.0 ± 13.3 years), were considered. IHM was related to: time of admission (daytime vs. nighttime, p = .015; WE vs. WD, p = .026, holidays vs. no holidays, p = .021), colour code (p < .001), and age (p < .001). Multivariate analysis showed an independent association with IHM for colour code (p < .001), and age (p < .001). LOS >7 days was related to: time of admission (daytime vs. nighttime, p < .001; WE or WD, p = .001; holidays vs. no holidays, p = .002). Furthermore, LOS >7 days depended on both colour code of admission (p < .001), and age (p < .001). Multivariate analysis showed a significant correlation with LOS >7 days for yellow colour code (p < .001), and age (p < .001). Conclusions:Although several factors, such as admission colour code and age, influence some parameters of clinical outcome, i.e., IHM and LOS, a striking weekend effect is not evident in a cohort of consecutive patients admitted to an Italian Medical Department, characterized by intermediate-high level of urgency.

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“…3,4,9,14,19 Recent publications included pediatric patients who underwent CSF shunt surgery among those who have experienced the weekend effect, with adverse outcomes seen in same-day weekend shunt revisions. 15 Authors have noted a risk of death, blood transfusion, and procedural complications for urgent weekend surgical admissions higher than that in patients who had urgent surgery during the week.…”

Section: Discussionmentioning

confidence: 99%

Reevaluating the weekend effect on patients with hydrocephalus undergoing operative shunt intervention

Attenello

Christian

Wen

et al. 2016

PED

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OBJECT Recently published data have suggested an increase in adverse outcomes in pediatric patients after insertion or revision of a ventricular CSF diversion shunt after a same-day weekend procedure. The authors undertook an evaluation of the impact of weekend admission and time to shunting on surgery-related quality outcomes in pediatric patients who underwent ventricular shunt insertion or revision. METHODS Pediatric patients with hydrocephalus who underwent ventriculoperitoneal, ventriculoatrial, or ventriculopleural shunt placement were selected from the 2000–2010 Nationwide Inpatient Sample and Kids’ Inpatient Database. Multivariate regression analyses (adjusted for patient, hospital, case severity, and time to shunting) were used to determine the differences in inpatient mortality and routine discharge rates among patients admitted on a weekday versus those among patients admitted on a weekend. RESULTS There were 99,472 pediatric patients with shunted hydrocephalus, 16% of whom were admitted on a weekend. After adjustment for disease severity, time to procedure, and admission acuity, weekend admission was not associated with an increase in the inpatient mortality rate (p = 0.46) or a change in the percentage of routine discharges (p = 0.98) after ventricular shunt procedures. In addition, associations were unchanged after an evaluation of patients who underwent shunt revision surgery. High-volume centers were incidentally noted in multivariate analysis to have increased rates of routine discharge (OR 1.04 [95% CI 1.01–1.07]; p = 0.02). CONCLUSIONS Contrary to those of previous studies, the authors’ data suggest that weekend admission is not associated with poorer outcomes for ventricular shunt insertion or revision. Increased rates of routine discharge were noted at high-volume centers.

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Effects of weekend admission and hospital teaching status on in-hospital mortality

Cited by 321 publications

References 15 publications

Excellent Hospital Care for All: Open and Operating 24/7

Excellent Hospital Care for All: Open and Operating 24/7

In-hospital mortality and length-of-stay in a cohort of ED patients admitted to internistic units

Reevaluating the weekend effect on patients with hydrocephalus undergoing operative shunt intervention

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