Mortality in out-of-hours emergency medical admissions – more than just a weekend effect

Maggs, Fenella; Mallet, Myriam

doi:10.4997/jrcpe.2010.205

Cited by 37 publications

(36 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our ability to investigate the effect of test results, admission time, and hospital workload are major strengths of this study. Previous studies have considered overnight versus daytime, or shift patterns in small studies, 22 in specific conditions, 23 or did not adjust for illness severity 10 . We analysed data from unselected emergency admissions, avoiding potential coding bias by restricting our analysis to specific subgroups 24 .…”

Section: Discussionmentioning

confidence: 99%

Mortality risks associated with emergency admissions during weekends and public holidays: an analysis of electronic health records

et al. 2017

View full text Add to dashboard Cite

SummaryBackgroundWeekend hospital admission is associated with increased mortality, but the contributions of varying illness severity and admission time to this weekend effect remain unexplored.MethodsWe analysed unselected emergency admissions to four Oxford University National Health Service hospitals in the UK from Jan 1, 2006, to Dec 31, 2014. The primary outcome was death within 30 days of admission (in or out of hospital), analysed using Cox models measuring time from admission. The primary exposure was day of the week of admission. We adjusted for multiple confounders including demographics, comorbidities, and admission characteristics, incorporating non-linearity and interactions. Models then considered the effect of adjusting for 15 common haematology and biochemistry test results or proxies for hospital workload.Findings257 596 individuals underwent 503 938 emergency admissions. 18 313 (4·7%) patients admitted as weekday energency admissions and 6070 (5·1%) patients admitted as weekend emergency admissions died within 30 days (p<0·0001). 9347 individuals underwent 9707 emergency admissions on public holidays. 559 (5·8%) died within 30 days (p<0·0001 vs weekday). 15 routine haematology and biochemistry test results were highly prognostic for mortality. In 271 465 (53·9%) admissions with complete data, adjustment for test results explained 33% (95% CI 21 to 70) of the excess mortality associated with emergency admission on Saturdays compared with Wednesdays, 52% (lower 95% CI 34) on Sundays, and 87% (lower 95% CI 45) on public holidays after adjustment for standard patient characteristics. Excess mortality was predominantly restricted to admissions between 1100 h and 1500 h (pinteraction=0·04). No hospital workload measure was independently associated with mortality (all p values >0·06).InterpretationAdjustment for routine test results substantially reduced excess mortality associated with emergency admission at weekends and public holidays. Adjustment for patient-level factors not available in our study might further reduce the residual excess mortality, particularly as this clustered around midday at weekends. Hospital workload was not associated with mortality. Together, these findings suggest that the weekend effect arises from patient-level differences at admission rather than reduced hospital staffing or services.FundingNIHR Oxford Biomedical Research Centre.

show abstract

Section: Discussionmentioning

confidence: 99%

Mortality risks associated with emergency admissions during weekends and public holidays: an analysis of electronic health records

et al. 2017

View full text Add to dashboard Cite

show abstract

“…4 9 19 20 It was consistent with a previous in-hospital mortality report of 7.96% among 15 594 emergency medical admissions to a single centre. 8 Examinations of unscheduled activity across multiple acute hospital trusts in England have reported an overall crude mortality rate of 5.0% 1 and an adjusted case fatality rate of 4.3% (range 2.5-6.4%). 6 However, these inpatient population studies included groups in the denominator which could have a lower short-term risk of death such as hospital transfers and direct ward admissions from primary care, and did not count deaths occurring in the community after discharge.…”

Section: Discussionmentioning

confidence: 99%

Retrospective observational study of emergency admission, readmission and the ‘weekend effect’

2017

View full text Add to dashboard Cite

ObjectivesExcess mortality following weekend hospital admission has been observed but not explained. As readmissions have greater age, comorbidity and social deprivation, outcomes following emergency index admission and readmission were examined for temporal and demographic associations to confirm whether weekend readmissions contribute towards excess mortality.DesignA retrospective observational study. Individual patient Hospital Episode Statistics were linked and 2 categories created: index admissions (not within 60 days of discharge from an emergency hospitalisation) and readmissions (within 60 days of discharge from an emergency hospitalisation). Logistic regression examined associations between admission category, weekend and weekday mortality, age, gender, season, comorbidity and social deprivation.SettingA single acute National Health Service (NHS) trust serving a population of 550 000 via 3 emergency departments.ParticipantsEmergency admissions between 1 January 2010 and 31 March 2015.Outcome measureAll-cause 30-day mortality.ResultsOver 5 years there were 128 966 index admissions (74.7% weekday/25.3% weekend) and 20 030 readmissions (74.9% weekday/25.1% weekend). Adjusted 30-day death rates for weekday/weekend admissions were 6.93%/7.04% for index cases and 12.26%/13.27% for readmissions. Weekend readmissions had a higher mortality risk relative to weekday readmissions (OR 1.10 (95% CI 1.01 to 1.20)) without differences in comorbidity or deprivation. Weekend index admissions did not have a significantly increased mortality risk (OR 1.04 (95% CI 0.98 to 1.11)) but deaths which did occur were associated with lower deprivation (OR 1.24 (95% CI 1.11 to 1.38)) and an absence of comorbidities (OR 1.17 (1.02 to 1.34)).ConclusionsAssociations with emergency hospitalisation were not identical for index admissions and readmissions. Further research is needed to confirm what factors are responsible for the ‘weekend effect’.

show abstract

“…Differences in the delivery of care in hospital during weekend hours due to reduced overall staffing levels, less senior and less experienced staff, and less supervision have all been quoted as possible explanations for the higher mortality which is called as 'weekend effect'. [6] The same reasons can be applied for higher mortality during holidays and night time. In addition, studies have shown that sleep deprivation of physicians is associated with a decline in performance [7,8], which may be a reason for higher mortality at night.…”

Section: Discussionmentioning

confidence: 99%

Mortality Among Patients Admitted To Intensive Care Unit On Weekends And Holidays Compared With Weekdays

Panda¹,

Singh²,

Padhihari³

et al. 2017

IOSR JDMS

View full text Add to dashboard Cite

Mortality in out-of-hours emergency medical admissions – more than just a weekend effect

Cited by 37 publications

References 22 publications

Mortality risks associated with emergency admissions during weekends and public holidays: an analysis of electronic health records

Mortality risks associated with emergency admissions during weekends and public holidays: an analysis of electronic health records

Retrospective observational study of emergency admission, readmission and the ‘weekend effect’

Mortality Among Patients Admitted To Intensive Care Unit On Weekends And Holidays Compared With Weekdays

Contact Info

Product

Resources

About