Impact of an Intervention to Improve Weekend Hospital Care at an Academic Medical Center: An Observational Study

Abstract

BACKGROUND: Hospital care on weekends has been associated with delays in care, reduced quality, and poor clinical outcomes. OBJECTIVE: The purpose of this study was to evaluate the impact of a weekend hospital intervention on processes of care and clinical outcomes. The multifaceted intervention included expanded weekend diagnostic services, improved weekend discharge processes, and increased physician and care management services on weekends. DESIGN AND PATIENTS: This was an interrupted time series observational study of adult non-obstetric patients hospitalized at a single academic medical center between January 2011 and January 2014. The study included 18 months prior to and 19 months following the implementation of the intervention. Data were analyzed using segmented regression analysis with adjustment for confounders. MAIN MEASURES: The primary outcome was average length of stay. Secondary outcomes included percent of patients discharged on weekends, 30-day readmission rate, and in-hospital mortality rate. KEY RESULTS: The study included 57,163 hospitalizations. Following implementation of the intervention, average length of stay decreased by 13 % (95 % CI 10-15 %) and continued to decrease by 1 % (95 % CI 1-2 %) per month as compared to the underlying time trend. The proportion of weekend discharges increased by 12 % (95 % CI 2-22 %) at the time of the intervention and continued to increase by 2 % (95 % CI 1-3 %) per month thereafter. The intervention had no impact on r e a d m i s s i o n s o r m o r t a l i t y. D u r i n g t h e p o s timplementation period, the hospital was evacuated and closed for 2 months due to damage from Hurricane Sandy, and a new hospital-wide electronic health record was introduced. The contributions of these events to our findings are not known. We observed a lower inpatient census and found differences in patient characteristics, including higher rates of Medicaid insurance and comorbidities, in the post-Hurricane Sandy period as compared to the pre-Sandy period. CONCLUSIONS:The intervention was associated with a reduction in length of stay and an increase in weekend discharges. Our longitudinal study also illuminated the challenges of evaluating the effectiveness of a large-scale intervention in a real-world hospital setting.

Off-hours presentation is associated with short-term mortality but not with long-term mortality in patients with ST-segment elevation myocardial infarction: A meta-analysis

“…Black et al speculated that the severity of sick patients who present during off-hours, rather than the quality of hospital care, is the reason for the differences in mortality[ 35 ]. Expanding diagnostic services, improved discharge processes and increased staffing management, including doctors and nurses, may be viable approaches to reduce the adverse effects of off-hours presentation[ 36 ].…”

Outcomes of off- and on-hours admission in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

“…To reduce the unfavorable effect of off-hours admission, an intervention, including expanded diagnostic services, improved discharge processes and increased physician management during off-hours might be a good choice. [ 26 ]…”

Seven-day services in surgery and weekend effect at a Japanese teaching hospital: a retrospective cohort study

“…In South Africa, tertiary hospitals have begun performing elective surgeries on Saturdays to help eliminate the 4-6month backlog of patients awaiting surgery [2]. In the U.S., an academic medical centre launched "The 7-Day Hospital Initiative", a multifaceted intervention that sought to improve weekend hospital care by expanding access to diagnostic procedures and increasing the number of weekend elective surgeries for primarily outpatients [3]. In the U.K., the National Health Service introduced a 7-day service programme in acute hospitals to help ensure that admitted emergency patients receive highquality care throughout the week [4].…”