¿Qué hay del efecto fin de semana? Impacto del día de ingreso sobre la mortalidad intrahospitalaria, la duración de la estancia y el coste de la hospitalización

To analyse mortality associated to emergency admissions on weekends, differentiating whether the patients were admitted to the Internal Medicine department or to the hospital as a whole. Retrospective follow-up study of patients discharged between 2015 and 2019 in: (a) the Internal Medicine department (n = 7656) and (b) the hospital as a whole (n = 83,146). Logistic regression models were fitted to analyse the risk of death, adjusting for age, sex, severity, Charlson index, sepsis, pneumonia, heart failure and day of admission. Cox models were also adjusted for the time from admission until normal inpatient care. There was a significant increase in mortality for patients admitted in weekends with short stays in Internal Medicine (48, 72 and 96 h: OR = 2.50, 1.89 and 1.62, respectively), and hospital-wide (OR = 2.02, 1.41 and 1.13, respectively). The highest risk in weekends occurred on Fridays (stays ≤ 48 h: OR = 3.92 [95% CI 2.06–7.48]), being no significative on Sundays. The risk increased with the time elapsed from admission until the inpatient department took over care (OR = 5.51 [95% CI 1.42–21.40] when this time reached 4 days). In Cox models patients reached HR = 2.74 (1.00–7.54) when the delay was 4 days. Whether it was Internal Medicine or hospital-wide patients, the risk of death associated with emergency admission in WE increased with the time between admission and transfer of care to the inpatient department; consequently, Friday was the day with the highest risk while Sunday lacked a weekend effect. Healthcare systems should correct this serious problem.

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Hospital mortality: The weekend effect and the time between emergency admission and the start of normal inpatient care

Castaño-Pérez,

Medina-García,

de León

2023

Preprint

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Objectives To analyse mortality associated to emergency admissions on weekends and holidays (WE), differentiating whether the patients were admitted to the Internal Medicine department or to the hospital as a whole.Methods Retrospective follow-up study of patients discharged between 2015 and 2019 in: a) the Internal Medicine (IM) department (n = 7656) and b) the hospital as a whole (n = 83146). Logistic regression models were fitted to analyse mortality.Results There was a significant increase in mortality for patients admitted in WE with short stays in IM (48, 72 and 96 hours: OR = 2.50, 1.89 and 1.62, respectively), and hospital-wide (OR = 2.02, 1.41 and 1.13). The highest risk per WE admission occurred on Fridays (stays ≤ 48 hours: OR = 3.92 [95% CI = 2.06–7.48] in IM), with no effect on Sundays. The risk of death increased with the time elapsed from admission until the inpatient department took over care (OR = 5.51 [95% CI = 1.42–21.40] in IM when this time reached 4 days).Conclusions Whether it was MI patients or hospital-wide patients, the risk of death associated with emergency admission in WE increased with the time between admission and transfer of care to the inpatient department; consequently, Friday was the day with the highest risk while Sunday lacked a weekend effect. Healthcare systems should correct this serious problem.

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¿Qué hay del efecto fin de semana? Impacto del día de ingreso sobre la mortalidad intrahospitalaria, la duración de la estancia y el coste de la hospitalización

Cited by 4 publications

References 17 publications

Patterns and outcomes of weekend admission for acute ischemic stroke

Patterns and outcomes of weekend admission for acute ischemic stroke

The dose–response effect of time between emergency admission and inpatient care on mortality

Hospital mortality: The weekend effect and the time between emergency admission and the start of normal inpatient care

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