Dying for the Weekend

Palmer, William; Bottle, Alex; Davie, Charlie; Vincent, Charles; Aylin, Paul

doi:10.1001/archneurol.2012.1030

Cited by 90 publications

(32 citation statements)

References 21 publications

(17 reference statements)

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“…Numerous published studies in the past have showed a “weekend effect” for various acute conditions like gastrointestinal hemorrhage, where patients admitted on weekends had worse clinical outcomes, higher hospital charges and longer LOS 17 18 19. ERCP is a technically challenging and resource-intensive procedure that may require coordination of gastroenterologists, trained nursing staff and sometimes anesthesia services, which is difficult to obtain during the weekends.…”

Section: Discussionmentioning

confidence: 99%

Utilization trends in inpatient endoscopic retrograde cholangiopancreatography (ERCP): A cross-sectional US experience

et al. 2017

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Study aims The goal of our study was to determine the current trends for inpatient utilization for endoscopic retrograde cholangiopancreatography (ERCP) and its economic impact in the United States between 2002 and 2013. Patients and methods A Nationwide Inpatient Sample from 2002 through 2013 was examined. We identified ERCPs using International Classification of Diseases (ICD-9) codes; Procedure codes 51.10, 51.11, 52.13, 51.14, 51.15, 52.14 and 52.92 for diagnostic and 51.84, 51.86, 52.97 were studied. Rate of inpatient ERCP was calculated. The trends for therapeutic ERCPs were compared to the diagnostic ones. We analyzed patient and hospital characteristics, length of hospital stay, and cost of care after adjusting for weighted samples. We used the Cochran-Armitage test for categorical variables and linear regression for continuous variables. Results A total of 411,409 ERCPs were performed from 2002 to 2013. The mean age was 59 ± 19 years; 61 % were female and 57 % were white. The total numbers of ERCPS increased by 12 % from 2002 to 2011, which was followed by a 10 % decrease in the number of ERCPs between 2011 and 2013.There was a significant increase in therapeutic ERCPs by 37 %, and a decrease in diagnostic ERCPs by 57 % from 2002 to 2013. Mean length of stay was 7 days (SE = 0.01) and the mean cost of hospitalization was $20,022 (SE = 41). Conclusions Our large cross-sectional study shows a significant shift in ERCPs towards therapeutic indications and a decline in its conventional diagnostic utility. Overall there has been a reduction in inpatient ERCPs.

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Section: Discussionmentioning

confidence: 99%

Utilization trends in inpatient endoscopic retrograde cholangiopancreatography (ERCP): A cross-sectional US experience

et al. 2017

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“…In the largest previous cohort study from England, patients admitted on a Sunday were found to have 26% higher odds of inpatient mortality compared to those admitted on a weekday [17]. However, the study was based on administrative data returns and was therefore limited in its ability to control for stroke severity between weekend and weekday admissions.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Out of Hours Presentation with Acute Stroke on Processes of Care and Outcomes: Analysis of Data from the Stroke Improvement National Audit Programme (SINAP)

et al. 2014

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BackgroundThere is inconsistent evidence that patients with stroke admitted to hospital out of regular working hours (such as weekends) experience worse outcomes. We aimed to identify if inequalities in the quality of care and mortality exist in contemporary stroke care in England.MethodsSINAP is a prospective database of acute stroke patients, documenting details of processes of care over the first 72 hours. We compared quality of care indicators and mortality at 72 hours, 7 days and 30 days, for patients who arrived within normal hours (Monday–Friday 8am to 6pm) and for those who arrived out of hours, using multivariable logistic and Cox proportional hazard models. Quality of care was defined according to time from arrival at hospital to interventions (e.g., brain scan), and whether the patient received therapeutic interventions (such as thrombolysis).Results45,726 stroke patients were admitted to 130 hospitals in England between 1 April 2010 and 31 January 2012. Patients admitted out of hours (n = 23779) had more features indicative of worse prognosis (haemorrhagic stroke, reduced consciousness, pre stroke dependency). Out of hours admission was significantly associated with longer delays in receiving a CT scan or being admitted to a stroke unit, and reduced odds of receiving thrombolysis. After adjusting for casemix, there was no consistent evidence of higher mortality for patients admitted out of hours, but patients admitted at the weekends had a higher risk of 30 day mortality (OR 1.14, 95% CI 1.06–1.21)ConclusionInequalities in the provision of stroke care for people admitted out of regular hours persist in contemporary stroke in England. The association with mortality is small and largely attributable to higher illness severity in patients admitted out of hours.

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“…Internationally, many but not all studies have reported increased mortality for admissions on weekends for high risk acute disorders such as myocardial infarction [14], stroke [15, 16], aortic aneurysm rupture [36], upper gastrointestinal bleeding [27, 37] and for all emergency conditions [17], although most increased risks were quite moderate, ranging from 5% to 20%. This indicates that these modest increased risks for emergency admissions on weekends may often be attributable largely to major high risk conditions.…”

Section: Discussionmentioning

confidence: 99%

Mortality following acute pancreatitis: social deprivation, hospital size and time of admission: record linkage study

et al. 2014

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BackgroundVery little is known about whether mortality following acute pancreatitis may be influenced by the following five factors: social deprivation, week day of admission, recruitment of junior doctors in August each year, European Working Time Directives (EWTDs) for junior doctors’ working hours and hospital size. The aim of this study was to establish how mortality following acute pancreatitis may be influenced by these five factors in a large cohort study.MethodsSystematic record linkage of inpatient, mortality and primary care data for 10 589 cases of acute pancreatitis in Wales, UK (population 3.0 million), from 1999 to 2010. The main study outcome measure was mortality at 60 days following the date of admission.ResultsMortality was 6.4% at 60 days. There was no significant variation in mortality according to social deprivation or the week day of admission. There was also no significant variation according to calendar month for acute pancreatitis overall or for gallstone aetiology, but for alcoholic acute pancreatitis, mortality was increased significantly by 93% for admissions during the months of August and September and 102% from August to October when compared with all other calendar months. Mortality was increased significantly for alcoholic aetiology in August 2004, the official month that the first EWTD was implemented, but there were no other increases following the first or second EWTDs. There were also indications of increased mortality in large hospitals when compared with small hospitals, for acute pancreatitis overall and for gallstone aetiology but not for alcoholic acute pancreatitis, although these increases in mortality were of quite marginal significance.ConclusionsAlthough we found some evidence of increased mortality for patients admitted with alcoholic acute pancreatitis during August to October, in August 2004, and in large hospitals for acute pancreatitis overall and for gallstone aetiology, the study factors had limited impact on mortality following acute pancreatitis and no significant impact when adjusted for multiple comparisons.

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Dying for the Weekend

Cited by 90 publications

References 21 publications

Utilization trends in inpatient endoscopic retrograde cholangiopancreatography (ERCP): A cross-sectional US experience

Utilization trends in inpatient endoscopic retrograde cholangiopancreatography (ERCP): A cross-sectional US experience

The Effect of Out of Hours Presentation with Acute Stroke on Processes of Care and Outcomes: Analysis of Data from the Stroke Improvement National Audit Programme (SINAP)

Mortality following acute pancreatitis: social deprivation, hospital size and time of admission: record linkage study

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