Impact of the “Weekend Effect” for Hospital Discharges on Readmissions After Elective Colectomy

Hoang, Chau M; Alavi, Karim; Flahive, Julie; Sturrock, Paul R.; Maykel, Justin A.; Davids, Jennifer S.

doi:10.1097/dcr.0000000000001272

Cited by 9 publications

(5 citation statements)

References 26 publications

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“…Previous studies have demonstrated that patients discharged on a weekend were at increased risk of readmission compared with patients discharged on a weekday if they required scheduled home health services. 36 In this study, we found inconsistency with access to services needed to develop a comprehensive discharge plan including access to advanced practice nurses, therapists, and admission to home healthcare programs that provide equipment and support at home. Weekend discharge often leads to a fragmented plan of action within this medically complex population leading to deficits in medication attainment, teaching, scheduling, and outpatient services.…”

Section: Advanced Practice Nurse Utilizationmentioning

confidence: 79%

A qualitative study evaluating the discharge process for vascular surgery patients to identify significant themes for organizational improvement

et al. 2022

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Objective Transition from the hospital to an outpatient setting is a multifaceted process requiring coordination among a variety of services and providers to ensure a high-quality discharge. Vascular surgery patients comprise a complex population that experiences high unplanned readmission rates. We performed a qualitative study to identify themes for process improvement for vascular surgery patients. A validated discharge process, RED (Re-Engineered Discharge), was used to identify additional actionable themes to create a more efficient discharge process tailored specifically to the vascular surgery population. Methods A prospective, qualitative analysis at a tertiary center using a semi-structured focus group interview guide was performed to evaluate the current discharge process and identify opportunities for improvement. Focus groups were Zoom recorded, transcribed into electronic text files, and were loaded into Dedoose qualitative software for analysis using a directed content analysis approach. Two researchers independently thematically coded each transcript, starting with accepted discharge components to identify new thematic categories. Prior to analysis, all redundancy of codes was resolved, and all team members agreed on text categorization and coding. Results Eight focus groups with a total of 38 participants were conducted. Participants included physicians ( n = 13), nursing/ancillary staff ( n = 14), advanced nurse practitioners ( n = 2), social worker/dietitian/pharmacist ( n = 3), and patients ( n = 6). Transcript analyses revealed facilitators and barriers to the discharge process. In addition to traditional RED components, unique concepts pertinent to vascular surgery patients included patient complexity, social determinants of health, technology literacy, complexity of ancillary services, discharge appropriateness, and use of advanced nurse practitioners for continuity. Conclusions Specific themes were identified to target and enhance the future vRED (vascular Re-Engineered Discharge) bundle. Thematic targets for improvement include increased planning, organization, and communication prior to discharge to address vascular surgery patients’ multiple comorbidities, extensive medication lists, and need for complex ancillary services at the time of discharge. Other thematic barriers discovered to improve include provider awareness of patient health literacy, patient understanding of complex discharge instructions, patient technology barriers, and intrinsic social determinants of health in this population. To address these discovered barriers, organizational targets to improve include enhanced social support, the use of advanced nurse practitioners for education reinforcement, and increased coordination. These results provide a framework for future quality improvement targeting the vascular surgery discharge process.

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Section: Advanced Practice Nurse Utilizationmentioning

confidence: 79%

A qualitative study evaluating the discharge process for vascular surgery patients to identify significant themes for organizational improvement

et al. 2022

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“…Several studies investigated the effect of weekend discharge on readmission after other types of surgery than esophagectomy. None found higher readmission rates after weekend discharge [41][42][43][44][45]. All of these studies included patients both with and without complications.…”

Section: Discussionmentioning

confidence: 99%

Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement

et al. 2020

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Background Within the scope of value-based health care, this study aimed to analyze Dutch hospital performance in terms of length of hospital stay after esophageal cancer surgery and its association with 30-day readmission rates. Since both parameters are influenced by the occurrence of complications, this study only included patients with an uneventful recovery after esophagectomy. Methods All patients registered in the Dutch Upper Gastrointestinal Cancer Audit (DUCA) who underwent a potentially curative esophagectomy between 2015 and 2018 were considered for inclusion. Patients were excluded in case of an intraoperative/post-operative complication, readmission to the intensive care unit, or any re-intervention. Length of hospital stay was dichotomized around the national median into ‘short admissions’ and ‘long admissions’. Hospital variation was evaluated using a case-mix-corrected funnel plot based on multivariable logistic regression analyses. Association of length of hospital stay with 30-day readmission rates was investigated using the χ2-statistic. Results A total of 1007 patients was included. National median length of hospital stay was 9 days, ranging from 6.5 to 12.5 days among 17 hospitals. The percentage of ‘short admissions’ per hospital ranged from 7.7 to 93.5%. After correction for case-mix variables, 3 hospitals had significantly higher ‘short admission’ rates and 4 hospitals had significantly lower ‘short admission’ rates. Overall, 6.2% [hospital variation (0.0–13.2%)] of patients were readmitted. Hospital 30-day readmission rates were not significantly different between patients with a short length of hospital stay and those with a long length of hospital stay (5.5% versus 7.6%; p = 0.19). Conclusions Based on these nationwide audit data, median length of hospital stay after an uncomplicated esophagectomy was 9 days ranging from 6.5 to 12.5 days among Dutch hospitals. There was no association between length of hospital stay and readmission rates. Nationwide improvement might lead to a substantial reduction of hospital costs.

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“…The "weekend effect" can be attributed to various factors, including the fact that many patients with longterm medical needs are discharged from the hospital on weekends. Insufficient access to diagnostic or therapeutic interventions, unavailability of skilled ancillary staff, or unavailability of post-discharge service scheduling are just some of the reasons that can cause physicians to delay discharge until the weekdays [21].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Common General Surgery Patients Discharged Over Weekends at a Tertiary Care Hospital in Taif, Saudi Arabia

Alsulaimani¹,

Alzahrani²,

Towairgi³

et al. 2022

Cureus

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Introduction: The admission of patients on weekends in multiple health centers has been associated with poorer outcomes relative to care provided during regular weekday hours. This study aimed to assess and compare the health outcomes of patients discharged on weekends and weekdays after undergoing surgery in a tertiary hospital in Taif, Saudi Arabia.Materials and methods: The data of patients were collected from hospital records in a retrospective manner, and the outcomes were assessed after discharge. Patients discharged on Friday and Saturday were considered weekend discharges, and those discharged on other days were considered weekday discharges. Data related to readmission and emergency department (ED) visits included the primary diagnosis, number of days post-primary discharge, length of stay, chief complaint, and the number of ED visits. A logistic regression model was done to assess the predictive factor for 30-readmission after surgery.Results: The frequency of discharge over the weekend was 9.1%. About 6.5% and 7.3% were found to have 30-day readmission and 30-day ED visits, respectively. A statistically significant association was not observed between weekend discharge and the development of postoperative complications (p>0.05). A multinomial logistic regression showed that patients who had emergency admission, postoperative complications, and the presence of cancer were found to be independently associated with 30-day readmission after discharge (P<0.05). Conclusion:Proactive strategies to reduce costly readmissions after surgery can be designed once the highrisk patient subset is identified.

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Impact of the “Weekend Effect” for Hospital Discharges on Readmissions After Elective Colectomy

Cited by 9 publications

References 26 publications

A qualitative study evaluating the discharge process for vascular surgery patients to identify significant themes for organizational improvement

A qualitative study evaluating the discharge process for vascular surgery patients to identify significant themes for organizational improvement

Length of hospital stay after uncomplicated esophagectomy. Hospital variation shows room for nationwide improvement

Outcomes of Common General Surgery Patients Discharged Over Weekends at a Tertiary Care Hospital in Taif, Saudi Arabia

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