Is weekend discharge associated with hospital readmission?

Cloyd, Jordan M.; Chen, Joy C.; Ma, Yifei; Rhoads, Kim F.

doi:10.1002/jhm.2406

Cited by 15 publications

(13 citation statements)

References 41 publications

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“…In our study there were significantly fewer discharges on the weekend (17.1%) compared to weekdays. This is consistent with the international literature where weekend discharge rates vary between 14.3% and 23.3% . This drop in discharge numbers may be due to reduced hospital staffing levels on the weekend (especially of senior staff) and more restricted access to community services .…”

Section: Discussionsupporting

confidence: 90%

“…In fact by day 30 there was a significantly lower incidence of adverse outcomes seen in the patients discharged on the weekend. This is consistent with most studies in the literature, which shows non‐inferiority for a weekend discharge and suggests that the enacted policy for discharges from these hospitals on the weekend is too conservative; an important issue to address if we want to improve hospital flow and efficiency.…”

Section: Discussionsupporting

confidence: 89%

“…Some studies show that readmission and mortality rates are higher for patients discharged on the weekend than for those discharged on weekdays . Other studies claim that there is no difference in adverse outcomes for weekend discharges so the reduced number of discharges on weekends might, in part, be caused by uncertainty concerning the outcomes for any patients discharged on the weekend.…”

Section: Introductionmentioning

confidence: 99%

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Similar outcomes for general medicine patients discharged on any day of the week

Horwood

Hakendorf

et al. 2019

Internal Medicine Journal

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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Similar outcomes for general medicine patients discharged on any day of the week

Horwood

Hakendorf

et al. 2019

Internal Medicine Journal

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“…2,3 A report from the Bureau of Health Information suggests that in New South Wales, between 14% and 20% of patients discharged with four common clinical conditions (congestive heart failure, pneumonia, acute myocardial infarction and stroke) were readmitted to a different hospital. 4 In fact, non-index hospital readmission rates can exceed 60%; 5 therefore, readmission rates are more meaningful when calculated on unplanned readmissions to all hospitals in a region rather than just the index hospital.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and clinical outcomes of index versus non-index hospital readmissions in Australian hospitals: a cohort study

Sharma

Horwood

Hakendorf

et al. 2020

Aust. Health Review

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Objective Risk factors and clinical outcomes of non-index hospital readmissions (readmissions to a hospital different from the previous admission) have not been studied in Australia. The present study compared characteristics and clinical outcomes between index and non-index hospital readmissions in the Australian healthcare setting. Methods This retrospective cohort study included medical admissions from 2012 to 2016 across all major public hospitals in South Australia. Readmissions within 30 day to all public hospitals were captured using electronic health information system. In-hospital mortality and readmission length of hospital stay (LOS) were compared, along with 30-day mortality and subsequent readmissions among patients readmitted to index or non-index hospitals. Results Of 114105 index admissions, there were 20539 (18.0%) readmissions. Of these, 17519 (85.3%) were index readmissions and 3020 (14.7%) were non-index readmissions. Compared with index readmissions, patients in the non-index readmissions group had a lower Charlson comorbidity index, shorter LOS and fewer complications during the index admission and were more likely to be readmitted with a different diagnosis to the index admission. No difference in in-hospital mortality was observed, but readmission LOS was shorter and 30-day mortality was higher among patients with non-index readmissions. Conclusion A substantial proportion of patients experienced non-index hospital readmissions. Non-index hospital readmitted patients had no immediate adverse outcomes, but experienced worse 30-day outcomes. What is known about the topic? A significant proportion of unplanned hospital readmissions occur to non-index hospitals. North American studies suggest that non-index hospital readmissions are associated with worse outcomes for patients due to discontinuity of care, medical reconciliation and delayed treatment. Limited studies have determined factors associated with non-index hospital readmissions in Australia, but whether such readmissions lead to adverse clinical outcomes is unknown. What does this paper add? In the Australian healthcare setting, 14.7% of patients were readmitted to non-index hospitals. Compared with index hospital readmissions, patients admitted to non-index hospitals had a lower Charlson comorbidity index, a shorter index LOS and fewer complications during the index admission. At the time of readmission there was no differences in discharge summary completion rates between the two groups. Unlike other studies, the present study found no immediate adverse outcomes for patients readmitted to non-index hospitals, but 30-day outcomes were worse than for patients who had an index hospital readmission. What are the implications for practitioners? Non-index hospital readmissions may not be totally preventable due to factors such as ambulance diversions stemming from emergency department overcrowding and prolonged emergency department waiting times. Patients should be advised to re-present to hospital in case they experience recurrence or relapse of a medical condition, and preferably should be readmitted to the same hospital to prevent discontinuity of care.

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“… 10 A second study by Cloyd et al reported similar readmission rates among patients with heart failure and pneumonia discharged over the weekend, despite a shorter length of stay (LOS) in hospital and lower availability of outpatient resources. 11 This raises the issue that LOS might be increased by avoiding discharges on the weekend. Previous studies showed that discharging fewer patients over a weekend compared to being discharged on a weekday, resulted in unnecessary increases in the LOS.…”

mentioning

confidence: 99%

Outcomes of common general surgery procedures for patients discharged over weekends at a tertiary care hospital in Saudi Arabia

Albabtain

Alsuhaibani

Almalki

et al. 2018

Annals of Saudi Medicine

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BACKGROUNDHospitals usually reduce staffing levels and services over weekends. This raises the question of whether patients discharged over a weekend may be inadequately prepared and possibly at higher risk of adverse events post-discharge.OBJECTIVESTo assess the outcomes of common general surgery procedures for patients discharged over weekends, and to identify the key predictors of early readmission.DESIGNRetrospective cohort study.SETTINGA tertiary care center.PATIENTS AND METHODSPatients discharged from general surgery services during the one-year period between January and December 2016 after cholecystectomy, appendectomy, or hernia repairs were included. Patient demographic information, comorbidities, and complications as well as admission and follow-up details were collected from electronic medical records.MAIN OUTCOME MEASURESOutcomes following weekend discharge, and the predictors of early readmission.SAMPLE SIZE743 patients.RESULTSThe operations performed: 361 patients (48.6%) underwent a cholecystectomy, 288 (38.8%) an appendectomy, and 94 (12.6%) hernia repairs. A significantly lower number of patients were discharged over the weekend (n=125) compared to those discharged on weekdays (n=618). Patients discharged during the weekend were younger, less likely to have chronic diseases, and had a significantly shorter average length of stay (LOS) (median 2 days, IQR: 1, 4 vs. median 3 days, IQR: 1, 5, P=.002). Overall, the 30-day readmission rate was 3.2% (n=24), and weekend discharge (OR=2.25, 95% CI 0.52–9.70) or any other variable did not predict readmission in 30 days. However, 14-day post-discharge follow-up visits were significantly lower in the weekend discharge subgroup (83.1% vs. 91.2%, P=.006).CONCLUSIONWeekend discharge was not associated with higher readmission rates. Physicians may consider discharging post-operative patients over a weekend without an increased risk to the patient. Day of discharge, length of stay and increased patient age are not predictors of early readmission.LIMITATIONSSingle-center study and retrospective.

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Is weekend discharge associated with hospital readmission?

Abstract: BACKGROUND: Although recent evidence suggests worse outcomes for patients admitted to the hospital on a weekend, the impact of weekend discharge is less understood.

Cited by 15 publications

References 41 publications

Similar outcomes for general medicine patients discharged on any day of the week

Similar outcomes for general medicine patients discharged on any day of the week

Characteristics and clinical outcomes of index versus non-index hospital readmissions in Australian hospitals: a cohort study

Outcomes of common general surgery procedures for patients discharged over weekends at a tertiary care hospital in Saudi Arabia

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