Paediatric outcomes and timing of admission

Abstract

Studies of adult patients have demonstrated that weekend admissions compared with weekday admissions had a significantly higher hospital mortality rate. We have reviewed the literature to determine if the timing of admission, for example, weekend or weekday, influenced mortality and morbidity in children. Seventeen studies reported the effect of timing of admission on mortality, and only four studies demonstrated an increase in those admitted at the weekend. Meta-analysis of the results of 15 of the studies demonstrated there was no significant weekend effect. There was, however, considerable heterogeneity in the studies. There were two large UK studies: one reported an increased mortality only for planned weekend admissions likely explained by planned admissions for complex conditions and the other showed no significant weekend effect. Two studies, one of which was large (n=2913), reported more surgical complications in infants undergoing weekend oesophageal atresia and trachea-oesophageal repair. Medication errors have also been reported to be more common at weekends. Five studies reported the effect of length of stay, meta-analysis demonstrated a significantly increased length of stay following a weekend admission, the mean difference was approximately 1 day. Those data, however, should be interpreted with the caveat that there was no adjustment in all of the studies for differences in disease severity. We conclude that weekend admission overall does not increase mortality but may be associated with a longer length of stay and, in certain conditions, with greater morbidity.

Healthcare processes of laboratory tests for the prediction of mortality in the intensive care unit: a retrospective study based on electronic healthcare records in the USA

“…Variables associated with healthcare processes, such as the time of day of the test, can therefore provide additional insight into the patient’s health, which can improve the accuracy of predictive models. Some widely investigated healthcare processes, including the timing of hospital admission, surgical procedures on weekends and handover during anaesthesia, have been shown to be associated with clinical outcomes 1–4. More recently, healthcare processes of the laboratory tests, such as the hour of day for ordering a test, day of the week and period since the last test, have been investigated in the hospitalised patients, and the results showed that these healthcare process variables were associated with the survival outcome, independent of their pathophysiology values 5.…”

Outcomes after admission on weekend day compared with weekday

“…An important point which was not discussed by Ramsden et al 1 is that the population of children admitted over the weekend is skewed towards the sicker end of the disease severity spectrum in comparison with children admitted on Mondays to Fridays, and this may explain some of the apparently ‘poorer’ outcomes after a weekend admission. While fewer children are admitted per day on Saturdays and Sundays, there is a 20% increase in admission with asthma and diabetes compared with weekdays,2 and the absolute number requiring high dependency and intensive care is constant 7 days a week 2.…”

“…The findings of Ramsden et al ’s review1 are replicated in our study of all admissions to hospitals in Scotland in 2000–2013 2. Our study was published too late for inclusion in the Ramsden  et al ’s review,1 but also found no evidence of increased mortality after a weekend admission, and we did find evidence of longer duration of admission in the form of a 7% reduction in zero day admissions over weekends compared with weekdays2 (ie, where a child is admitted and discharged home on the same day).…”

“…The systematic review by Ramsden et al 1 provides reassuring evidence that in-hospital mortality is not increased over weekends compared with weekdays. The systematic review1 also identifies increased length of stay and greater morbidity for children admitted over the weekends compared with weekdays, and these observations may understandably cause concern for parents, healthcare staff and hospital administrators.…”

“…The systematic review1 also identifies increased length of stay and greater morbidity for children admitted over the weekends compared with weekdays, and these observations may understandably cause concern for parents, healthcare staff and hospital administrators.…”