Incidence of "never events" among weekend admissions versus weekday admissions to US hospitals: national analysis

Abstract

ObjeCtive To evaluate the association between weekend admission to hospital and 14 hospital acquired conditions recently considered by the Centers for Medicare and Medicaid as "never events," serious, costly, and preventable medical errors, for which resulting healthcare costs are not reimbursed. Design National analysis.setting US Nationwide Inpatient Sample discharge database.

Impact of the 2003 ACGME Resident Duty Hour Reform on Hospital-Acquired Conditions: A National Retrospective Analysis

“…Finally, to account for the missing data, we conducted a multiple imputation analysis using the methods outlined by Berglund 21 and adapted for the NIS as our tertiary analysis. 10 This study was declared exempt by the University of Southern California Health Sciences Campus Institutional Review Board.…”

“…Our results are consistent with the findings of other aggregate NIS studies. 10,16 The association of reforms with increased HAC frequency may be due to multiple reasons. Increased number of informational exchanges during handoffs has been cited as a source of medical errors in multiple studies.…”

“…7 These events represented hospital-acquired conditions (HACs), such as catheter-associated urinary tract infections, which are deemed serious, costly, and resulting from preventable medical errors, subsequently not qualifying for CMS reimbursement (BOX). [8][9][10] Indicators aimed to shift the burden of complications from patients to hospitals as an incentive to accelerate safety programs. 11,12 The CMS recently estimated there have been 50 000 lives and $12 billion saved since the creation of the HAC program (2010)(2011)(2012)(2013)(2014), with a 17% decrease in HACs.…”

“…15 HACs have been utilized as hospital quality outcome measures in studies. 10,11,16,17 No prior study has evaluated the national incidence of HACs before and after the institution of the 2003 ACGME duty hour limits. Each discharge was treated as an independent event due to the lack of unique patient identifiers.…”

“…The Elixhauser comorbidity index is a set of comprehensive comorbidity measures associated with in-hospital mortality, all-cause mortality, and health care expenditures, designed for the use of large administrative databases and utilized in many prior NIS studies. 10,16,19,20 HACs were defined using CMS-provided criteria by means of International Classification of Disease, ninth revision, Clinical Modification. 8 Outcomes of interest included occurrence of HACs, prolonged length of stay (pLOS), and elevated inpatient costs.…”