Safe, High Quality Care Around the Clock: What will it Take to Get us There?

Mourad, Michelle; Adler, Josh

doi:10.1007/s11606-011-1795-5

Cited by 4 publications

(5 citation statements)

References 35 publications

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“…Staff number and skill mix, physician cross coverage, and availability of diagnostic and therapeutic resources have each been implicated as a source for increased adverse outcomes in weekend admissions. 11 Previous adult studies found associations between hospital teaching status, physician staffing and skill level, and nurse staffing and skill level and patient outcomes. [27][28][29][30][31][32] These analyses identified the presence of pediatric hematology-oncology fellowship during year of admission as a hospital factor that was independently associated with increased hospital LOS (0.8 days; 95% CI, 0.1 to 1.5).…”

Section: Discussionmentioning

confidence: 99%

“…This process could help hospitals rectify areas with insufficient resources that are necessary to appropriately address care needs of the higher-acuity patient. 11 Of course, increasing the availability of resources on the weekends in anticipation of higher-acuity patients may result in increased hospital expenditures without necessarily decreasing negative patient outcomes. Previous literature suggests mixed findings regarding the cost-effectiveness of increasing nurse staffing on the weekends to improvement in patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Other potentially important factors were not studied including patient acuity and staffing quality. 11 Understanding whether weekend admission increases the risk for adverse outcomes in pediatric patients with leukemia and potential modifying factors could support altering hospital staffing models and increasing availability of diagnostic and therapeutic procedures on weekends.…”

mentioning

confidence: 99%

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Association of Weekend Admission With Hospital Length of Stay, Time to Chemotherapy, and Risk for Respiratory Failure in Pediatric Patients With Newly Diagnosed Leukemia at Freestanding US Children’s Hospitals

et al. 2014

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IMPORTANCE In adult patients with leukemia, weekend admission is associated with increased inpatient mortality. It is unknown whether weekend diagnostic admissions in pediatric patients with leukemia demonstrate similar adverse outcomes. OBJECTIVE To estimate adverse clinical outcomes associated with weekend admission in the first hospitalization of pediatric patients with newly diagnosed leukemia. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study from 1999 to 2011 featured index hospital admissions identified from the Pediatric Health Information System database. Participants were children with newly diagnosed acute lymphoid leukemia or acute myeloid leukemia. EXPOSURES Weekend (Saturday and Sunday) or weekday index admission. MAIN OUTCOMES AND MEASURES Inpatient mortality, length of inpatient stay, time to chemotherapy, and organ-system failure in index admission. RESULTS A total of 10 720 patients with acute lymphoid leukemia and 1323 patients with acute myeloid leukemia were identified; 2009 patients (16.7%) were admitted on the weekend. While the total daily number of patients receiving intensive care unit–level care was constant regardless of the day of admission, these patients represented a larger percentage of total admissions on weekends. In adjusted analyses, patients admitted on the weekend did not have an increased rate of mortality during the first admission (odds ratio, 1.0; 95% CI, 0.8–1.6). Patients whose initial admission for leukemia occurred during a weekend had a significantly increased length of stay (1.4-day increase; 95% CI, 0.7–2.1), time to initiation of chemotherapy (0.36-day increase; 95% CI, 0.3–0.5), and risk for respiratory failure (odds ratio, 1.5; 95% CI, 1.2–1.7) after adjusting for demographics, severity of illness, and hospital-level factors. CONCLUSIONS AND RELEVANCE While pediatric patients with newly diagnosed leukemia admitted on weekends do not have higher mortality rates, they have a prolonged length of stay, increased time to chemotherapy, and higher risk for respiratory failure. Patients who are severely ill at presentation represent a higher proportion of weekend index admissions. Optimizing weekend resources by increasing staffing and access to diagnostic and therapeutic resources may help to reduce hospital length of stay across all weekend admissions and may also ensure the availability of comprehensive care for those weekend admissions with higher acuity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Association of Weekend Admission With Hospital Length of Stay, Time to Chemotherapy, and Risk for Respiratory Failure in Pediatric Patients With Newly Diagnosed Leukemia at Freestanding US Children’s Hospitals

et al. 2014

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“…Increasing nurse and physician staffing levels and skill mix to cover any potential shortfall on weekends may be expensive, although theoretically, there may be savings accrued from reduced adverse events and shorter length of stay. 26,52 Changes to weekend care might only benefit daytime hospitalizations because some studies have shown increased mortality during nighttime regardless of weekend or weekday admission. 53 Several methodologic points in our study need to be clarified.…”

Section: Discussionmentioning

confidence: 99%

The Weekend Effect in Hospitalized Patients: A Meta‐Analysis

Pauls¹,

Johnson-Paben²,

McGready

et al. 2017

Journal of Hospital Medicine

129

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“…However, the association has not been found in all studies [24] , and the question about whether, and if so, how, different models of care deliver equivalent outcomes to patients admitted on weekends has received little research attention. Reduced levels of staffing on the weekend have been proposed as one possible cause of excess mortality [25] , [26] . There is, however, very little evidence that weekend staffing levels are associated with patient outcomes, and we are aware of no studies specifically addressing this question in stroke care.…”

Section: Discussionmentioning

confidence: 99%