Postdischarge Outcomes in Heart Failure Are Better for Teaching Hospitals and Weekday Discharges

McAlister, Finlay A.; Au, Anita G.; Majumdar, Sumit R.; Youngson, Erik; Padwal, Raj

doi:10.1161/circheartfailure.113.000336

Cited by 28 publications

(37 citation statements)

References 40 publications

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“…In our previous study of over 24,000 heart failure patients discharged over 10 years (up to June 2009, therefore no overlap with any patients in this study), we also found that patients discharged on the weekends were younger, had fewer comorbidities, and shorter lengths of stay. Although postdischarge death/readmission rates were higher for weekend discharged patients in our earlier study (21.1% vs 19.5%, adjusted hazard ratio: 1.15, 95% CI: 1.06–1.25), it is worth noting that this was almost entirely driven by data from nonteaching hospitals and cardiology wards.…”

Section: Discussionsupporting

confidence: 71%

Similar outcomes among general medicine patients discharged on weekends

McAlister

Youngson

Padwal

et al. 2014

Journal of Hospital Medicine

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BACKGROUND Hospitals reduce staffing levels and services on weekends. This raises the question of whether weekend discharges may be inadequately prepared and thus at higher risk for adverse events postdischarge. OBJECTIVE To compare death or nonelective readmission rates 30 days after weekend versus weekday discharge. DESIGN Retrospective cohort. SETTING All teaching hospitals in Alberta, Canada. PATIENTS General internal medicine (GIM) discharges (only 1 per patient). MEASUREMENTS Analyses were adjusted for demographics, comorbidity, and length of stay based on a previously validated index. RESULTS Of 7991 patients (mean age, 62.1 years; 51.9% male; mean Charlson 2.56; 57.5% LACE ≥10) discharged from 7 teaching hospitals, 1146 (14.3%) were discharged on a weekend. Although they had substantially shorter lengths of stay (5.64 days, 95% confidence interval [CI]: 5.35–5.93 vs 7.86 days, 95% CI: 7.71–8.00, adjusted P value < 0.0001) and were less likely to be discharged with homecare support (10.9% vs 19.3%) or to long‐term care facilities (3.1% vs 7.8%), patients discharged on weekends exhibited similar rates of death or readmission at 30 days compared to those discharged on weekdays (10.6% vs 13.2%, adjusted odds ratio [aOR]: 0.94, 95% CI: 0.77–1.16), even among the 4591 patients deemed to be at high risk for postdischarge events based on LACE (length of hospital stay, acuity of admission, comorbidity burden quantified using the Charlson Comorbidity Index, and emergency department visits in the 6 months prior to admission) score ≥10 (16.8% vs 16.5% for weekday discharges, aOR: 1.09 [95% CI: 0.85–1.41]). CONCLUSIONS GIM patients discharged from teaching hospitals on weekends have shorter lengths of stay and exhibit similar postdischarge outcomes as patients discharged on weekdays. Journal of Hospital Medicine 2015;10:69–74. © 2014 Society of Hospital Medicine

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Section: Discussionsupporting

confidence: 71%

Similar outcomes among general medicine patients discharged on weekends

McAlister

Youngson

Padwal

et al. 2014

Journal of Hospital Medicine

Self Cite

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show abstract

“…Most strikingly, only the healthiest patients were discharged on weekends. These results are similar to findings from the authors' previous work on patients hospitalized with heart failure . Yet the implications for discharge planning are much less clear, as the few analyses of discharge day from the authors and others do not account for the range of factors that may influence risk after hospitalization such as patients' clinical characteristics, the quality of both hospital and transitional care, and the posthospital environments to which patients are discharged.…”

supporting

confidence: 69%

Risk after hospitalization: We have a lot to learn

Dharmarajan

Krumholz

2015

Journal of Hospital Medicine

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“…A study of heart failure patients found increased risk of readmission with weekend discharges, though this effect was isolated to nonteaching hospitals. 11 Kidney transplant patients discharged on the weekend also had a higher risk of 30-day readmission. 12 However, a recent Canadian study found no difference in readmission or mortality rates among internal medicine patients discharged on the weekend.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10] It is unclear whether limited support on the weekend is associated with worse discharge outcomes, such as higher readmission rates, higher mortality, or poor postdischarge follow-up. 5,11,12 Chronic obstructive pulmonary disease (COPD) is a common condition, affecting 12.7 million Americans, leading to 1.2 million hospitalizations, and costing $53.7 billion dollars annually. 13,14 Approximately 20% of patients hospitalized for COPD are readmitted within 30 days of discharge.…”

mentioning

confidence: 99%